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Mycotic aneurysms are rare and if left untreated, can have devastating outcomes. In this case, a 72-year-old man presented to hospital with fevers, night sweats and abdominal pain. A CT scan revealed the development an infrarenal pseudoaneurysm over the course of 8 weeks, increasing from 2.8 cm to a 3.1 cm. The aneurysm was not present on a CT scan performed 6 months earlier. The patient underwent an emergency endovascular repair of the aortic aneurysm (EVAR) and was placed on broad-spectrum antibiotics. Intra-aortic blood cultures aspirated adjacent to the aneurysm and tissue biopsy confirmed tuberculosis bovis as the cause of the mycotic aneurysm. The patient had been treated with intravesical BCG for transitional cell carcinoma of the bladder several months prior. The patient was treated with an extended course of antituberculosis medication. He recovered well and was back to his baseline function within weeks.

A passively powered wireless sensor based on an inductive-capacitive-resistive (LCR) sensor was developed to measure tensile stress at suture anchors used to repair soft tissue injuries such as ligament and tendon tears. The sensor, which is completely embedded within the suture anchor, consists of a strain gauge mounted on a substrate with a loop connector so a suture can pass through. When the suture experiences a tensile stress, it pulls at the loop connector and the strain gauge, allowing measurement of tensile stress at the suture. In this study, sensors of different designs were fabricated and characterized ex vivo to determine their force sensing capabilities. The effects of sensor placement and orientation on accuracy were also characterized. The LCR suture anchor sensor can be used to assess the quality of soft tissue treatments, such as rotator cuff repairs, as well as to detect failure of the implant post-surgery. The advantages of this sensor are its small size, wireless detection, and battery-free operation, making it ideal for use with both short- and long-term implants.

Expression of miR-154 is upregulated in the diseased heart and was previously shown to be upregulated in the lungs of patients with pulmonary fibrosis. However, the role of miR-154 in a model of sustained pressure overload-induced cardiac hypertrophy and fibrosis had not been assessed. To examine the role of miR-154 in the diseased heart, adult male mice were subjected to transverse aortic constriction for four weeks and echocardiography was performed to confirm left ventricular hypertrophy and cardiac dysfunction. Mice were then subcutaneously administered a locked nucleic acid antimiR-154 or control over three consecutive days (25 mg/kg/day) and cardiac function was assessed 8 weeks later. Here, we demonstrate that therapeutic inhibition of miR-154 in mice with pathological hypertrophy was able to protect against cardiac dysfunction and attenuate adverse cardiac remodelling. The improved cardiac phenotype was associated with attenuation of heart and cardiomyocyte size, less cardiac fibrosis, lower expression of atrial and B-type natriuretic peptide genes, attenuation of profibrotic markers and increased expression of p15 (a miR-154 target and cell cycle inhibitor). In summary, this study suggests that miR-154 may represent a novel target for the treatment of cardiac pathologies associated with cardiac fibrosis, hypertrophy and dysfunction.

INTRODUCTION This study aimed to investigate the clinicopathological patterns and survival outcomes of patients with young-onset colorectal cancer (CRC) in Malaysia. METHODS A total of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,715 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002–2016 were included. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009–2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients. RESULTS The overall proportion of young-onset CRC was 10.7%. The mean age for young-onset CRC was 39.5 ± 7.4 years, with a male-to-female ratio of 1.2:1. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRCs were diagnosed at an advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, the OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and the treatment modality used were independent prognostic factors. CONCLUSION The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, both groups were equivalent.

BACKGROUND Prognostication of myeloproliferative neoplasm (MPN) has always been challenging, even with the advent of Janus kinase 2 (JAK2 V617F) molecular studies. The survival pattern of patients diagnosed with MPN in developing countries is still undetermined. MATERIALS AND METHODS The national MPN registry conducted from 2009 to 2015 in Malaysia provided a comprehensive insight into the demographics, clinical characteristics and laboratory parameters of patients diagnosed with MPN nationwide. The study analysed the survival patterns and mortality outcomes and risk among 671 patients diagnosed with essential thrombocythaemia (ET), polycythaemia vera (PV), primary myelofibrosis (PMF) and unclassified MPN (MPN-U). Mortality status was traced and confirmed until the end of December 2018, with right censoring applied to patients alive beyond that. RESULTS The analysed cohort consisted of 283 (42.2%) ET, 269 (40.1%) PV, 62 (9.2%) PMF and 57 (8.5%) MPN-U incident cases with diagnosis made between 2007 and 2015. The majority of patients were male (52.3%) and Malay (48.9%), except for ET, in which the majority of patients were female (60.1%) and of Chinese origin (47.0%). Female patients were found to have significantly better overall survival (OS) rates in ET (p = 0.0285) and MPN-U (p = 0.0070). Patients with JAK2 V617F mutation were found to have marginally inferior OS over time. Multivariable Cox regression identified patients with increased age [hazard ratio (HR) 1.055, 95% CI 1.031; 1.064], reduced haemoglobin (HB) level (HR 0.886, 95% CI 0.831; 0.945, p = 0.0002), being male (HR 1.545, 95% CI 1.077; 2.217, p = 0.0182), and having MPN-U (HR 2.383, 95% CI 1.261; 4.503, p = 0.0075) and PMF (HR 1.975, 95% CI 1.054; 3.701, p = 0.0335) at increased risk for worse mortality outcomes. CONCLUSION Myeloproliferative neoplasm reduces patient survival. The degree of impact on survival varies according to sub-type, sex, bone marrow fibrosis and HB levels. The JAK2 V617F mutation was not found to affect the survival pattern or mortality outcome significantly.

There is an increasing need for tactile shear sensors, particularly for medical applications such as orthopedic rehabilitation. Examples include measuring interfacial shear stresses between a residual limb and prosthesis to monitor socket fit and improve residual limb tissue health, and tracking shearing between a foot and shoe for assessing performance in athletes. However, there are considerable challenges in implementing shear force sensors for orthopedic applications due to the requirements for noninvasiveness, low mass, low power, and robustness against motion artifacts, normal force, and/or electromagnetic fields. To address these challenges, we designed, fabricated, and characterized a simple, low-cost, optoelectronic sensor that can measure multi-axial shear stresses. This novel sensor is based on a red, green, and blue (RGB) light-emitting diode (LED) projecting a cyclic illumination of RGB light onto a color pattern surface. As shear strain causes a displacement between the LED and the color pattern, the intensities of the reflected lights change due to the shift of the color pattern position. A photodiode captures the reflected light intensity at each color illumination, allowing the determination of the color pattern surface displacement and the shear along two axes. In this paper, we also report the efficacy of the sensor under benchtop testing conditions, confirming the potential of this technology for shear monitoring in orthopedic devices such as protheses or shoes. Future efforts will focus on miniaturization and packaging of the sensors, and characterizing their performance for the aforementioned medical applications.

This community service is carried out in foreign cooperation where the partner is Professor Dr. Salmi Mohd Isa, Yuvaraj A / L Ganesan, Ooi Say Keat, Ph.D from the Graduate School of Business, University Sains Malaysia. We give this community service activity with the theme "Counseling on the Accounting Profession and the Importance of Financial Reports as a Form of Accountability for Stakeholders in Students of SMKN 2 Tangerang Selatan. The target of this activity is students of class XII. They were given material explanations about the accounting profession, what accounting is and how it processes, preparation of financial reports, the use of financial reports, accountability and stakeholders. The implementation will be carried out in a Vicon fashion in the form of a Webinar around February 2021 (In Syaa Allah). Participants will be given material modules and certificates as well as internet credit money reimbursements. The results of the expected activities are that the student participants of SMKN 2 Tangerang Selatan gain an understanding of the accounting profession, what accounting is, how to record transactions to compile financial reports to how accountable they are to stakeholders. So that students of SMKKN 2 South Tangerang understand very well about the accounting profession and can determine their choice of fields for further study or work and if they choose the field of accounting then understand the importance of financial reports as a form of accountability for stakeholders. Evaluation can be done by looking for information at graduation through the counseling guidance teacher and the homeroom teacher regarding the plans of the students.

Background The World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on urological services in different geographical areas is unknown. Objective To investigate the global impact of COVID-19 on urological providers and the provision of urological patient care. Design, setting, and participants A cross-sectional, web-based survey was conducted from March 30, 2020 to April 7, 2020. A 55-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of urological services. Target respondents were practising urologists, urology trainees, and urology nurses/advanced practice providers. Outcome measurements and statistical analysis The primary outcome was the degree of reduction in urological services, which was further stratified by the geographical location, degree of outbreak, and nature and urgency of urological conditions. The secondary outcome was the duration of delay in urological services. Results and limitations A total of 1004 participants responded to our survey, and they were mostly based in Asia, Europe, North America, and South America. Worldwide, 41% of the respondents reported that their hospital staff members had been diagnosed with COVID-19 infection, 27% reported personnel shortage, and 26% had to be deployed to take care of COVID-19 patients. Globally, only 33% of the respondents felt that they were given adequate personal protective equipment, and many providers expressed fear of going to work (47%). It was of concerning that 13% of the respondents were advised not to wear a surgical face mask for the fear of scaring their patients, and 21% of the respondents were advised not to discuss COVID-19 issues or concerns on media. COVID-19 had a global impact on the cut-down of urological services, including outpatient clinic appointments, outpatient investigations and procedures, and urological surgeries. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak. On average, 28% of outpatient clinics, 30% of outpatient investigations and procedures, and 31% of urological surgeries had a delay of >8 wk. Urological services for benign conditions were more affected than those for malignant conditions. Finally, 47% of the respondents believed that the accumulated workload could be dealt with in a timely manner after the COVID-19 outbreak, but 50% thought the postponement of urological services would affect the treatment and survival outcomes of their patients. One of the limitations of this study is that Africa, Australia, and New Zealand were under-represented. Conclusions COVID-19 had a profound global impact on urological care and urology providers. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak and was greater for benign than for malignant conditions. One-fourth of urological providers were deployed to assist with COVID-19 care. Many providers reported insufficient personal protective equipment and support from hospital administration. Patient summary Coronavirus disease-19 (COVID-19) has led to significant delay in outpatient care and surgery in urology, particularly in regions with the most COVID-19 cases. A considerable proportion of urology health care professionals have been deployed to assist in COVID-19 care, despite the perception of insufficient training and protective equipment., Take Home Message The coronavirus disease-19 (COVID-19) pandemic has imposed great challenges to the urological community globally. The impact of COVID-19 on urological services increased with the degree of outbreak, and resulted in significant delay in the delivery of urological care.

The COVID-19 pandemic has created novel barriers in providing and accessing all forms of healthcare, including dentistry. The national dental response during the first peak of the pandemic resulted in rapid changes in the provision of service, to safeguard providers and users of dental care. Such rapidly leveraged changes resulted in several issues in service delivery, requiring careful input from managers and commissioners within NHS England and Improvement, trainees and consultants in dental public health within Public Health England, and frontline dental teams working across the health and social care system. The local response from Lancashire and South Cumbria is outlined within this article. Teamwork, communication and reflexive, iterative learning from these groups ensured the delivery of an Urgent Dental Care service during the first lockdown of the pandemic. The impact of COVID-19 has enabled considerable learning which will inform future pandemic planning, alongside providing the opportunity to deliver meaningful change within NHS dentistry as the service continues to recover.

Introduction: The COVID-19 pandemic has affected the world for more than a year, with multiple waves of infections resulting in morbidity, mortality and disruption to the economy and society. Response measures employed to control it have generally been effective but are unlikely to be sustainable over the long term. Methods: We examined the evidence for a vaccine-driven COVID-19 exit strategy including academic papers, governmental reports and epidemiological data, and discuss the shift from the current pandemic footing to an endemic approach similar to influenza and other re spiratory infectious diseases. Results: A desired endemic state is characterised by a baseline prevalence of infections with a generally mild disease profile that can be sustainably managed by the healthcare system, together with the resumption of near normalcy in human activities. Such an endemic state is attainable for COVID-19 given the promising data around vaccine efficacy, although uncertainty remains around vaccine immunity escape in emergent variants of concern. Maintenance of non-pharmaceutical interventions remains crucial until high vaccination coverage is attained to avoid runaway outbreaks. It may also be worthwhile to de-escalate measures in phases, before standing down most measures for an endemic state. If a variant that substantially evades immunity emerges, it will need to be managed akin to a new disease threat, with pandemic preparedness and response plans. Conclusion: An endemic state for COVID-19, characterised by sustainable disease control measures, is likely attainable through vaccination. Keywords: COVID-19, endemic, non-pharmaceutical interventions, transition, vaccination

Purpose This study aims to identify the key variables which determine intentions to visit coffee/tea tourism plantations particularly those adopting sustainable practices. Also, this study ascertained the perception of risk in travelling due to the fear of Covid-19 on travel intentions to such coffee/tea tourism destinations. Design/methodology/approach Using the theory of planned behaviour as a basis for this study’s framework, data was gathered from 302 eco-conscious Generation Y and Z consumers via an online survey. Partial least squares were then applied to analyse the data. Findings Learning and relaxation motives were important in determining consumers’ attitudes towards sustainable coffee/tea tourism. The intention to engage in sustainable coffee/tea tourism is most strongly affected by the risk of travelling, followed by attitude. Research limitations/implications The addition of contemporary variables was given to the theory of planned behaviour’s core constructs to better reflect consumers’ attitude and behaviour towards a growing form of tourism under unprecedented times. Practical implications Travel or tourism operators will have first-hand insights on the factors that drive intentions to visit sustainable coffee and tea destinations, thus enabling more strategic action to be undertaken to reach the targeted young consumers. Originality/value This study examines young, environmental-conscious consumers’ perspectives on novel travel destinations which adopt sustainable practices. Risk in travelling was assessed which is necessary given Covid-19 has severely disrupted consumers’ travel patterns.

Background COVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period. Methods We conducted a retrospective study in a tertiary care hospital in Singapore. The study compared the incidence and outcomes of code blue activations over a 3-month period from March to May 2020 (COVID-19 period) with the same months in 2019 (pre-COVID-19 period). The primary outcome of the study was the rate of survival to hospital discharge for IHCA. The secondary outcomes included incidence of all code blue activation per 1000 hospital admissions, incidence of IHCA per 1000 hospital admissions. Outcomes The rate of survival to hospital discharge for IHCA was 5.88% in the COVID-19 period as compared to 10.0% in the pre-COVID-19 period [odds ratio (OR), 0.72; 95% confidence interval (CI), 0.26-1.95]. Compared to pre-COVID-19 period, there were more IHCA incidences per 1000 hospital admissions in the COVID-19 period (1.86 vs 1.03; OR, 1.81; 95% CI, 0.78-4.41). Conclusions The study observed a trend towards higher incidence of IHCA and lower rate of survival to hospital discharge during COVID-19 pandemic compared to pre-COVID-19 period.

The Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral illness generally manifests as a mild disease in young children and immunocompromised adults. It has however emerged as a significant public health threat in recent years as outbreaks have been occurring regularly, especially in the Asia–Pacific. The disease can result from infections by a wide variety of human enteroviruses, particularly, Enterovirus A71 (EV-A71) has garnered more attention due to its association with severe disease in infected patients. Despite the potential to result severe neurological complications or even fatality, there is currently no effective antiviral for treatment of EV-A71 infections and the only vaccines available are restricted to distribution in China. In this study, we report the in vitro and in vivo evaluation of two candidate antiviral compounds active against EV-A71, a viral capsid inhibitor (G197) and a novel host-targeting phosphatidylinositol 4-kinase III beta inhibitor (N373) which, especially when used in combination, can significantly improve the survival and pathology of infected mice.

Background: One of the many challenges faced by universities in developing countries is to equip graduates with practical skills and knowledge for the demanding workforce. The traditional textbook-...

In Malaysia, chronic respiratory disease including COPD is responsible for 7% of the total Disability-Adjusted Life Years (DALYs). Sleep disturbance in COPD patients is often underestimated and overlooked clinically. Respiratory symptoms caused by COPD often leads to poor sleep quality and insomnia. Poor sleep quality contributes to frequent episodes of exacerbation which directly increases mortality risk. This study aims to determine health-related quality of life and sleep quality among COPD patients and their associations with severity. In this cross-sectional study, 102 COPD patients classified according to Global Initiative for Chronic Obstructive Lung Disease were evaluated. EQ5D and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to assess health-related quality of life and sleep quality respectively. Results showed the severity of COPD is significantly associated (p5) with a mean g l o b a l score of 6.93 ± 4.072. Sleep quality was also found to be significantly associated (p

Marwa Elsaeed Elhefnawy,1 Siti Maisharah Sheikh Ghadzi,1 Balamurugan Tangiisuran,1 Hadzliana Zainal,1 Irene Looi,2 Khairul Azmi Ibrahim,3 Norsima Nazifah Sidek,3 Keat Wei Loo,4 Keng Yee Lee,5 Zariah Abdul Aziz,3 Sabariah Noor Harun1 1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia; 2Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia; 3Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia; 4Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) Kampar Campus, Perak, Malaysia; 5National Clinical Research Centre, Kuala Lumpur, MalaysiaCorrespondence: Sabariah Noor HarunDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, MalaysiaTel +604-6532487Email sabariahnoor@usm.myBackground and Purpose: Factors associated with ischemic stroke (IS) recurrence and the contribution of pharmacological treatment as secondary preventions among nondiabetics especially in the non-elderly population are unclear and not widely investigated. This was a population-based study that aimed to identify recurrent IS predictors and to determine the possible impact of secondary preventive medications on the IS recurrence in non-elderly adults with or without diabetes.Methods: Data of 3386 patients < 60 years old who had a history of index IS were extracted from the Malaysian National Neurology Registry (NNEUR) from 2009 to 2016. Recurrent IS was defined as any IS event recorded after the index IS in the NNEUR database. Multivariate logistic regression analysis was performed by using SPSS version 22.Results: Ischemic heart disease (IHD) was the significant predictor of IS recurrence in non-elderly adults both with or without diabetes (adjusted odds ratio (AOR) of 3.210; 95%CI: 1.909– 5.398 and 2.989; 95%CI: 1.515– 5.894) respectively). Receiving antiplatelet as secondary stroke prevention (AOR: 0.194; 95%CI: 0.046– 0.817) and continuation of antidiabetic medication after the index IS event (AOR: 0.510; 95%CI: 0.298– 0.872) reduced the odds of IS recurrence only in non-elderly diabetic adults. Among non-elderly adults without diabetes, hyperlipidemia and every increased in 1 mmHg of systolic blood pressure significantly increased the odds of IS recurrence following the indexing event (AOR: 1.796; 95%CI: 1.058– 3.051 and 1.009; 95%CI: 1.002– 1.016 respectively).Conclusion: IHD was found as the main predictor of IS recurrence regardless of diabetes status in non-elderly adults after the index IS event. Receiving antidiabetic and antiplatelet medications upon discharge after index IS were significant predictors of recurrent IS in non-elderly diabetic adults. A proper randomized clinical trial may be required to determine the impact of secondary preventive medication on IS recurrence, especially in non-elderly adults.Keywords: ischemic stroke, recurrence, prevention, diabetic, nondiabetic, non-elderly

Counterfeit currency can have detrimental effects on the economy of a country. The effects include inflation, as well as black marketing and misfortunes to commerce and administrations. This study ...

Kamaruddin Mardhiah,1,2 Nadiah Wan-Arfah,2 Nyi Nyi Naing,3 Muhammad Radzi Abu Hassan,4 Huan-Keat Chan,4 Hazriah Hasan1 1Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia; 2Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia; 3Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia; 4Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, MalaysiaCorrespondence: Nadiah Wan-ArfahFaculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, Kuala Terengganu, Terengganu, 21300, MalaysiaTel +6012-6260508Email wanwaj@unisza.edu.myPurpose: This study was conducted to determine the direct medical cost of treating melioidosis patients. The calculation was made according to the variables extracted from medical records.Materials and Methods: Data collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients’ status and duration of stay at the hospital using the independent t-test.Results: The overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P> 0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥ 14 duration of stay was higher compared to those with < 14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died.Conclusion: Despite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.Keywords: melioidosis, direct medical cost, trend analysis

Regulatory T cells (Tregs) are often enriched in tumors, where their immunosuppressive function has a key role in tumor persistence and progression. In colorectal cancer (CRC), however, Tregs are frequently associated with an improved clinical outcome. Tumor-infiltrating Tregs have been shown to exhibit a distinct signature comprising the co-stimulatory molecules (OX40, 4-1BB), cytokine receptors (IL1R2, IL21R, CCR8, CD30), and co-inhibitory molecules (PD-L1, TIGIT). Here, we showed by flow cytometry that circulating CD45RO+ Tregs from patients with CRC (n = 25) have elevated CD30 and OX40 expression compared to healthy subjects (n = 14). We identified co-expression of CD30 and OX40 on circulating CD45RO+ Tregs using single-cell images captured by the DEPArray™ system. The frequency of CD30+OX40+CD45RO+ Tregs was significantly higher in CRC patients than in healthy subjects (P +OX40+ Treg subset could strongly discriminate between CRC patients and healthy subjects with the highest accuracy of 92.3%, an AUC of 0.92, a sensitivity of 88%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 82.35%, and a trade-off value of 3.44%, compared to other Treg subsets. Consistently, multiplex-IHC/IF of tumor-infiltrating Tregs revealed a significant association between high densities of CD30+OX40+ Tregs and improved overall survival; no such association was found for other subsets. These data suggest a potential role for CD30+OX40+ Tregs as a diagnostic or prognostic biomarker in CRC.

Yilin Ning,1,2 Peh Joo Ho,3,4 Nathalie C Støer,5,6 Ka Keat Lim,7,8 Hwee-Lin Wee,3,9 Mikael Hartman,1– 3,10 Marie Reilly,11 Chuen Seng Tan3 1NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore; 2Yong Loo Lin School of Medicine, Department of Surgery, National University of Singapore and National University Health System, Singapore, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; 4Genome Institute of Singapore, Singapore, Singapore; 5Norwegian National Advisory Unit on Women’s Health, Oslo University Hospital, Oslo, Norway; 6Department of Research, Cancer Registry of Norway, Oslo, Norway; 7Department of Population Health Sciences, School of Population Health & Environmental Sciences (SPHES), Faculty of Life Sciences & Medicine, King’s College London, London, UK; 8Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; 9Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore; 10Department of Surgery, National University Hospital, Singapore, Singapore; 11Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenCorrespondence: Chuen Seng TanSaw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, SingaporeTel +65-66013206Email ephtcs@nus.edu.sgPurpose: Assessing the clinical importance of an exposure effect on a quality of life (QoL) score often requires quantifying the effect in terms of a difference in scores. Using the linear regression model (LRM) for this purpose assumes the ordinal score is a proxy for an underlying continuous variable, but the analysis offers no assessment for the validity of the assumption. We propose an approach that assesses the proxy assumption and estimates the exposure effect by using the cumulative link model (CLM).Patients and methods: CLM is a well-established regression model that assumes an ordinal score is an ordered category generated from applying thresholds to a latent continuous variable. Our approach assesses the proxy assumption by testing whether these thresholds are equidistant. We compared the performance of CLM and LRM using simulated ordinal data and illustrated their application to the effect of time since diagnosis on five subscales of fatigue among breast cancer survivors measured using the Multidimensional Fatigue Inventory.Results: CLM had good performance in estimating the difference in means with simulated ordinal data satisfying the proxy assumption, even when the outcome had only a few categories. When the proxy assumption was inadequate, both the CLM and LRM had biased estimates with poor coverage. The proxy assumption was appropriate for four ofthe five subscales in our real data application to fatigue scores, which highlighted the importance of assessing the proxy assumption to avoid reporting invalid estimates in terms of the difference in scores.Conclusion: The proxy assumption is critical to the interpretation of the exposure effect on the difference in mean QoL scores. CLM offers a valid test for the presence of an association, a method for assessing the proxy assumption, and when the assumption is adequate, an assessment for clinical significance using the difference in means.Keywords: cumulative link model, ordered probit model, ordinal outcome, ordinal regression, probit link, quality of life

Intensity of solar irradiance directly affects solar power generation and this makes solar irradiance forecasting a vital process in energy management systems. Existing forecasting systems show positive solar irradiance forecasting performance, but most of them are not accurate in real-life especially when there are fast-moving clouds, causing highly fluctuating solar irradiance profile, which is difficult to predict. Moreover, the requirement to pre-train Artificial Intelligence-based forecasting system has made solar irradiance forecasting impractical as long-hour weather profiles need to be collected prior to deployment. This paper proposes a new artificial intelligent algorithm namely the Regression Enhanced Incremental Self-organising Neural Network (RE-SOINN) for accurate (even for highly fluctuating profile) and adaptive solar irradiance forecasting. This algorithm works by learning the time-series solar irradiance data incrementally and predicting it in real-time. It is novel in terms of enabling the learning of data from discrete (as in the conventional) to continuous using the regression method. The proposed algorithm further improves the prediction accuracy by decomposing the input data into two components (low and high frequency components) before feeding into the RE-SOINNs. Results showed that the proposed algorithm achieves higher accuracy compared to the Persistence model, Exponential Smoothing Model and Artificial Neural Networks.

INTRODUCTION Decompensation with ascites portends a poor prognosis in cirrhosis. The aim of this study was to compare the outcomes of patients with nonalcoholic steatohepatitis (NASH) with hepatitis B virus (HBV) cirrhosis after decompensation with ascites. METHODS We conducted a retrospective study to evaluate the outcomes of patients with NASH and HBV cirrhosis who were admitted to hospital for first-onset ascites from January 1, 2004, to June 30, 2015. They were followed up until death, liver transplantation, or loss to follow up. RESULTS Patients with NASH had lower median (interquartile range) Model for End-Stage Liver Disease score (11 [9-14] vs 14 [11-17], P < 0.001). Over 60 months, patients with NASH cirrhosis had higher cumulative incidence of dilutional hyponatremia (P < 0.001) and refractory ascites (P = 0.028). They also had higher cumulative incidence of cirrhosis-related deaths and liver transplantation compared with HBV cirrhosis (65.7%; [95% confidence interval (CI) 53.6-75.4] vs 42.5% [95% CI 32.4-55.2], P = 0.008). Multivariable competing risk analysis showed that NASH (subdistribution hazard ratio [sHR] 1.88 [95% CI 1.14-3.11], P = 0.014), non-Chinese ethnicity (sHR 1.63 [95% CI 1.06-2.50], P = 0.027), history of hepatocellular carcinoma (sHR 1.76 [95% CI 1.05-2.95], P = 0.033), estimated glomerular filtration rate

Primary repair or resection with anastomosis (PR/A) has been gaining increasing recognition for traumatic colonic injuries, with the need for faecal diversion (FD) especially those of penetrating etiology being questioned. However, the role of PR/A in critically ill patients is still controversial with concerns pertaining to safety and anastomotic leak. We performed a systemic review of studies comparing outcomes of FD versus PR/A in traumatic colonic injuries. A systematic review was performed as per PRISMA guidelines utilizing three electronic databases: Pubmed, EMBASE, and Cochrane Library resources. Mortality and anastomotic leak rates are identified as the primary and secondary outcomes, respectively. Data extracted include mortality rates, type of surgical intervention, surgical complications, and need for DC (damage control) surgery. Fourteen studies were identified comprising 11 retrospective, 2 prospective cohort and 1 randomized trial with a total of 2071 patients. Six studies included patients that underwent DC surgery. The overall mortality rate was 3.77% and was higher in the FD group compared to PR/A group (5.38% vs 2.49%, p = 0.07). 71.3% of patients underwent PR/A with an overall leak rate of 4.63%. There was no difference in intra-abdominal collections between the PR/A and FD groups. In the subgroup analysis, anastomotic leak rate was significantly higher in the DC group compared to non-DC group (16.7% vs 3.2%, p = 0.003). This meta-analysis supports PR/A in stable patients with traumatic colonic injuries. FD should be considered in critically ill patients who require DC surgery as leak rates are significantly higher.

The primary objective of this study is to compare the effectiveness of cricoid pressure (CP) and paralaryngeal pressure (PLP) on occlusion of eccentric esophagus in patients under general anesthesia (GA). Secondary objectives include the prevalence of patients with central or eccentric esophagus both before and after GA, and the success rate of CP in occluding centrally located esophagus in patients post GA. Fifty-one ASA physical status I and II patients, undergoing GA for elective surgery were enrolled in this study. Ultrasonography imaging were performed to determine the position of the esophagus relative to the trachea: (i) before induction of GA, (ii) after GA before external CP maneuver, (iii) after GA with CP, and (iv) after GA with PLP. CP was applied to all patients whilst PLP via fingertip technique was only applied to patients with an eccentric esophagus. Among a total of 51 patients, 28 of them (55%) had eccentric esophagus pre GA, while this number increase to 33 (65%) after induction of GA. CP success rate was 100% in 18 patients with central esophagus post GA versus 27% in 33 patients with eccentric esophagus post GA (P

The aim of this study is to provide insights and promotes awareness and understanding of related aging factors in oleochemical industry. Establish a framework to manage aging assets through computerized maintenance management system (CMMS). The methodology adopted was to identify key factors related to aging failure based on collation of incidents and breakdowns from one of the largest oleochemical industries in Malaysia. The databases of incident reports and breakdown were reviewed in detail and make judgment on whether or not any of them was a contributing factor to aging failure. The framework in aging asset management was developed based on multiple successful CMMS implementation and roll outs, suitable to be implemented in any CMMS software. The findings of data and reviews are incorporated into the framework to manage and maintain the service life of each aging assets in oleochemical industry effectively. The framework also helps and guides maintenance managers, engineers and practitioners understand aging factor, deal pragmatically with safety, environmental and business risk to meet statutory and company requirements. This research has shown that aging related failure M.O.D.E (maintenance, operation, design and environment) are significant contributor to aging related incident or breakdown in oleochemical industry. These aging assets can be managed effectively through guided and systematic framework in CMMS to address the aging related failure across all relevant asset types as available in oleochemical industry.

Military systems have become more complex, and the development of future advanced materials for defence applications has received much attention. Nanocellulose has been identified as a ‘super versatile material’ that will become a replacement material for many applications including in the military. Nanocellulose can be synthesized from discarded fibers that are left over from forestry and agricultural waste that can be transformed into high-value products. Thanks to its interesting properties, comprising low thermal expansion coefficient, high aspect ratio, high crystallinity, and good mechanical and optical properties, nanocellulose has emerged as a new material class for high end military products such as bulletproof vests, fire-retardant materials, as a component of propellants and filtration materials, and in textile, electronic and energy products. Therefore, in this review, current and future applications of nanocellulose in the military are critically discussed. This review is intended to impart to readers some of the excitement that currently surrounds nanocellulose research, and it's fascinating chemical and physical properties and applications in the military.

The distance between the anterior wall of the maxillary sinus and the nasolacrimal duct has been classified into three types by Simmen, in which type I (

Purpose To investigate the prevalence and epidemiological risk factors of olfactory and/or taste disorder (OTD), in particular isolated OTD, in patients with laboratory-confirmed COVID-19 infection. Methods We conducted a retrospective and cross-sectional study. Patients with laboratory-confirmed COVID-19 infection were recruited from the National Centre for Infectious Diseases (NCID) Singapore between 24 March 2020 and 16 April 2020. The electronic health records of these patients were accessed, and demographic data and symptoms reported (respiratory, self-reported OTD and other symptoms such as headache, myalgia and lethargy) were collected. Results A total of 1065 patients with laboratory-confirmed COVID-19 were recruited. Overall, the prevalence of OTD was 12.6%. Twelve patients (1.1%) had isolated OTD. The top three symptoms associated with OTD were cough, fever and sore throat. The symptoms of runny nose and blocked nose were experienced by only 29.8 and 19.3% of patients, respectively. Multivariate analysis demonstrated that the female gender, presence of blocked nose and absence of fever were significantly associated with OTD (adjusted relative risks 1.77, 3.31, 0.42, respectively). All these factors were statistically significant. Conclusion Patients with COVID-19 infection can present with OTD, either in isolation or in combination with other general symptoms. Certain demographic profile, such as being female, and symptomatology such as the presence of blocked nose and absence of fever, were more likely to have OTD when infected by COVID-19. Further studies to elucidate the pathophysiology of OTD in these patients will be beneficial.

PURPOSE To determine the incidence, demographic profile, background of reporters, causative agents, severity and clinical outcomes of hepatic adverse drug reaction (ADR) reports in Malaysia using the national ADR reporting database. METHODS The ADR reports recorded between 2000 and 2017 were retrospectively analysed to identify hepatic ADR reports. The trend and characteristics of hepatic ADR cases were described. Multivariate disproportionality analysis of the causative agents was performed to generate signals of hepatic ADRs. RESULTS A total of 2090 hepatic ADRs (1.77% of all ADRs) were reported with mortality rate of 12.7% among cases with known clinical outcomes. The incidence of hepatic ADR reporting in Malaysia increased significantly over 18 years from 0.26 to 9.45 per million population (P

Of late, disruptive innovation in financial services is driving the tremendous growth of cryptocurrency, with Bitcoin being the most popular virtual currency of interest among investors. Notwithstanding the volatility of the cryptocurrencies, Bitcoin preserves a core group of committed users. Despite concerns over security threats of digital transactions, little is known about Bitcoin users’ perceived security and trust in the Bitcoin system. As such, this paper aims to examine the underlying security features that lead to users’ perceived security and trust, and the role of perceived security and trust in explaining Bitcoin use. Structural equation modelling was used to analyse self-report questionnaires from 109 Bitcoin users. Technical protections, transaction procedures and security statements are the determinants of perceived security and trust towards Bitcoin. Nonetheless, findings of the importance-performance map analysis (IPMA) indicated that perceived security, perceived trust and technical protections are the areas of focus for increasing Bitcoin use. This paper offers several fruitful implications which could ultimately lead to the discussion on sustainability of cryptocurrency in financial markets.

Members of social network sites are able to decide how to present themselves to other members. An earlier study has suggested that athletes may put up posts to describe themselves in their various ...

Background To utilise Multiphoton Microscopy as a novel imaging technique to characterize and quantify collagen at the Renal Cell Carcinoma Pseudocapsule, to assess for both intra-tumoral and inter-tumoral variation of collagen characteristics. MPM combines Second Harmonic Generation and Two Photon Excitation Fluorescence to image extracellular matrix architecture. Methods 20 partial nephrectomy specimen tissues were retrieved, cut into 5‎-micron sections, mounted on slides and deparaffinized. The pseudocapsules were imaged with 2X and 20X objective at selected Regions of Interest. Corresponding clinical information was retrieved. Pseudocapsule thickness was determined. Collagen parameters measured included quantification by the Collagen Area Ratio, and qualitative measurements by the Collagen Fiber Density and Collagen Reticulation Index. Results The boundaries between tumor, PC and normal renal parenchyma were distinguished by Multiphoton Microscopy without the need for staining. In the thickest areas of the pseudocapsule, collagen content and density were quantitatively higher compared to the thinnest areas. Median Collagen Area Ratio was higher in the thickest compared to the thinnest areas of the PC (p=0.01). Clear Cell RCC specimens had a consistently higher Collagen Fiber Density in both the thickest and thinnest areas compared to non-Clear Cell RCC specimens (p=0.02). Conclusions In this study, we demonstrated the ability of Multiphoton Microscopy to quantify collagen characteristics of pseudocapsules without fluorescent labelling. Tumor enucleation for Renal Cell Carcinoma along its Pseudocapsule remains debatable with regards to oncological safety. Even with a complete and intact pseudocapsule, the pseudocapsule is not a homogenous structure, and varies in its thickness and its collagen characteristics within, and between, tumours.

Introduction: Point of care ultrasound (POCUS) has become essential in the management of critically ill patients. Multiple POCUS training courses exist, but are not widely adopted in Singapore. Given the discordance between training supply and demand, we aimed to uncover the learning needs and barriers among intensive care medicine (ICM) doctors locally. Materials and Methods: An anonymous online survey was carried out from January to April 2019 among ICM doctors from 6 major teaching hospitals in Singapore. Results: 66 out of 160 ICM specialists and trainees responded (41.3%). Although only 6% of respondents had current formal POCUS accreditation, the majority were already using critical care echocardiography (CCE) and pleural/ lung ultrasound. 93% supported having a local training programme. More than 50% of trainees wanted training in CCE, diaphragm/muscle ultrasound, airway ultrasound and ultrasound for neurological disease. More than 50% of specialists wanted training in diaphragm/muscle ultrasound, with mixed interests in other topics. The top 2 obstacles hindering POCUS training were lack of supervisors and locally based programmes. Conclusions: ICM doctors who responded were supportive of a local POCUS training programme. The programme’s curriculum should address the learning needs of the majority of learners, with diaphragm/muscle ultrasound being the top unmet need. The programme would need to develop supervisors and be as affordable as possible. Keywords: Continuing medical education, Cross-sectional survey, Intensive Care, Ultrasound

Introduction: Screening for diabetic retinopathy (DR) is critical in preventing visual loss. However, current tools are expensive, bulky and sensitive, thus limiting screening coverage, especially in developing areas such as the interior of Borneo. Smartphone-assisted devices may provide an alternative and this study seeks to determine the level of agreement between a smartphone retinal imaging adapter (SRIA) against conventional ones. Materials and methods: This was a cross-sectional study with Institutional Review Board approval from the Medical Ethics Board of University of Malaya Medical Centre. A total of 284 eyes from 142 patients included underwent retinal imaging using a conventional fundus camera and the SRIA. The images were graded according to Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. Agreement between both modalities was calculated using Cohen’s Kappa statistics. Results: The Kappa agreement between SRIA and conventional fundus imaging in grading individual ETDRS stages stood at 0.648 (p < 0.001), achieving up to 0.752 (p < 0.001) when differentiating between no DR, non-proliferative DR, and proliferative DR. Conclusion: DR grading SRIA and conventional fundus camera imaging were comparable. SRIA can be useful in eye screenings but still needs improvement.

We present herein our perspective of a novel Small Habitats Matrix (SHM) concept showing how small habitats on private lands are untapped but can be valuable for mitigating ecological degradation. Grounded by the realities in Sabah, Malaysian Borneo, we model a discontinuous “stepping stones” linkage that includes both terrestrial and aquatic habitats to illustrate exactly how the SHM can be deployed. Taken together, the SHM is expected to optimize the meta-population vitality in monoculture landscapes for aerial, arboreal, terrestrial and aquatic wildlife communities. We also provide the tangible cost estimates and discuss how such a concept is both economically affordable and plausible to complement global conservation initiatives. By proposing a practical approach to conservation in the rapidly developing tropics, we present a perspective from “ground zero” that reaches out to fellow scientists, funders, activists and pro-environmental land owners who often ask, “What more can we do?”

The aim of this study is the development of the ABS-CuZnFe2O4 composites using 3D printer. In this study, the effect of filler loading on the mechanical properties and thermal conductivity is examined. The result shows that at highest filler loading (14 wt%) the tensile strength was improved approximately 98 % while the Young’s modulus increased about 23 % compared to unfilled specimen. Meanwhile, the percentage of elongation decrease approximately about 49 % when filled with 14 wt% of filler. The CuZnFe2O4 filler shows a greater effect on hardness value of the composites around 498 % at maximum filler content. The thermal conductivity of the ABS increased up to 60 % at full capacity of filler.

Digital, OBJECTIVE Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study. RESEARCH DESIGN AND METHODS Data on 132,373 individuals aged 35–70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as, Ciencias Médicas y de la Salud

The thermoelectric properties of hexagonal SiGe doped with Sn with doping percentage of 12.5% and 25% were investigated using linearised augmented plane wave method using the WIEN2k package and semiclassical Boltztmann Transport equation using the BoltzTraP software for the purpose of understanding the role of Sn as a dopant in the SiGe. For temperature range of 300 to 1000 K, it can be seen that by doping with Sn, there is an improvement in overall thermal conductivity of the samples with the highest improvement is in the 25% doped sample. The conductivity vs temperature for 25% Sn doped SiGe also shows higher value through temperature range from 300 K to 1000 K, however the Seebeck coefficient decreases with Sn doping percentage for the same temperature range. Due to lower Seebeck coefficient and higher thermal conductivity values, the overall thermoelectric coefficient, ZT, of the doped compound is lower than the SiGe values with highest ZT equal to 0.29 and 0.17 at 650 K for 12.5% and 25% respectively while the ZT of simulated SiGe at 650 K is 0.35. Thus 25% Sn doping actually reduce the ZT but enhanced the thermal and electrical conductivity of SiGe for temperature range of 300 to 1000 K.

Introduction: Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU. Materials and Methods: A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records. Results: Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30–45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25–7) and 10 (8.25–12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173–213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9–17.75) and 16 days (IQR 12–32) respectively. Conclusion: Low COVID-19 ICU mortality was observed in our “pandemic-ready” ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes. Keywords: Acute respiratory distress syndrome, Coronavirus, Critical care, Pandemic, Pneumonia

Worldwide, the ESKAPE group of pathogens - Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species - are emerging as important pathogens which have acquired resistance towards different classes of antibiotics. Malaysia has also reported high levels of antibiotic resistance among these pathogens, based on prevalence data from hospital patients. However, the prevalence and antibiotic resistance rates of ESKAPE group members in the community are largely unknown. Therefore, this study focuses on acute pharyngitis (AP) patients from private primary care clinics in the Klang Valley, central Malaysia, as AP is the most common infection-associated reason for contact with private primary healthcare providers. Out of 205 patients, 119 were found to harbor ESKAPE group bacteria, where a total of 175 isolates were subjected to antibiotic susceptibility testing. Our results show that the most prevalent ESKAPE group member in this cohort is S. aureus, with one isolate found to be multidrug-resistant towards penicillin V, cefoxitin, erythromycin and azithromycin. We also report the first finding of community acquired resistance to cefotaxime in K. pneumoniae, imipenem in Enterobacter spp. and tetracycline, also in Enterobacter spp., in Malaysia, which were not derived from samples from a hospital setting. In conclusion, this study, which describes antibiotic resistance of community acquired ESKAPE pathogens in the Malaysian private primary healthcare setting highlights the need for a comprehensive centralized reporting system for community acquired antibiotic resistance to complement the Malaysian National Surveillance of Antibiotic Resistance.

Background and aim Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome. Worryingly, it has been increasingly reported among nonobese patients. This study aims to analyse patient characteristics of biopsy-proven NAFLD in an Asian cohort and explore differences stratified by body mass index (BMI). Methods Clinical, laboratory, and histological data were collected from 263 adults with biopsy-proven NAFLD. Patients with and without obesity (BMI cut-off 25) were compared. The ability to predict advanced liver fibrosis with three non-invasive scores, the NAFLD Fibrosis score (NFS), Fibrosis-4 (FIB4), and the aspartate aminotransferase to platelet ratio index (APRI), was compared. Results Obese subjects had a lower mean age (49.5 ± 12.5 vs 54.0 ± 12.9 years, P = 0.017), a higher prevalence of diabetes (52.4% vs 36.8%, P = 0.037), and a higher waist circumference (113.9 ± 16.0 cm vs 87.0 ± 18.4 cm, P = 0.022). The prevalence of dyslipidaemia (68.0% vs 61.4%, P = 0.353) and hypertension (61.7% vs 49.1%, P = 0.190) was comparable between the two groups. The distribution of non-alcoholic steatohepatitis (NASH) (63.1% versus 61.4%, P = 0.710) and advanced fibrosis (31.6% versus 26.3%, P = 0.447) were also similar in both groups. All three non-invasive scores (NFS, FIB4, and APRI) performed poorly in predicting advanced fibrosis in nonobese patients with NAFLD. The FIB4 was the most accurate non-invasive score in predicting advanced fibrosis in the obese group. Conclusions Obese and nonobese patients are equally at risk of NASH and advanced fibrosis. While the FIB4 is the most accurate non-invasive score in predicting advanced fibrosis among obese individuals, further research is warranted to develop a nonobese specific score to correctly identify nonobese NAFLD patients with advanced fibrosis.