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  1. E A R ENS, Irekeola AA, Yean Yean C
    Diagnostics (Basel), 2020 Aug 19;10(9).
    PMID: 32825179 DOI: 10.3390/diagnostics10090611
    Nasopharyngeal carcinoma (NPC) is a disease that is highly associated with the latent infection of Epstein-Barr virus. The absence of obvious clinical signs at the early stage of the disease has made early diagnosis practically impossible, thereby promoting the establishment and progression of the disease. To enhance the stride for a reliable and less invasive tool for the diagnosis and prognosis of NPC, we synopsize biomarkers belonging to the two most implicated biological domains (oncogenes and tumor suppressors) in NPC disease. Since no single biomarker is sufficient for diagnosis and prognosis, coupled with the fact that the known established methods such as methylation-specific polymerase chain reaction (PCR), multiplex methylation-specific PCR, microarray assays, etc., can only accommodate a few biomarkers, we propose a 10-biomarker panel (KIT, LMP1, PIKC3A, miR-141, and miR-18a/b (oncogenic) and p16, RASSF1A, DAP-kinase, miR-9, and miR-26a (tumor suppressors)) based on their diagnostic and prognostic values. This marker set could be explored in a multilevel or single unified assay for the diagnosis and prognosis of NPC. If carefully harnessed and standardized, it is hoped that the proposed marker set would help transform the diagnostic and prognostic realm of NPC, and ultimately, help prevent the life-threatening late-stage NPC disease.
  2. Jamal FN, Arafat Dzulkarnain AA, Shahrudin FA, Marzuki MN
    J Audiol Otol, 2021 Jan;25(1):14-21.
    PMID: 32575950 DOI: 10.7874/jao.2020.00073
    BACKGROUND AND OBJECTIVES: There is growing interest in the use of the Level-specific (LS) CE-Chirp® stimulus in auditory brainstem response (ABR) due to its ability to produce prominent ABR waves with robust amplitudes. There are no known studies that investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus. The present study aims to investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus and compare its reliability with the ABR to standard click stimulus at multiple intensity levels in normal-hearing adults.

    SUBJECTS AND METHODS: Eleven normal-hearing adults participated. The ABR test was repeated twice in the same clinical session and conducted again in another session. The ABR was acquired using both the click and LS CE-Chirp® stimuli at 4 presentation levels (80, 60, 40, and 20 dBnHL). Only the right ear was tested using the ipsilateral electrode montage. The reliability of the ABR findings (amplitudes and latencies) to the click and LS CE-Chirp® stimuli within the same clinical session and between the two clinical sessions was calculated using an intra-class correlation coefficient analysis (ICC).

    RESULTS: The results showed a significant correlation of the ABR findings (amplitude and latencies) to both stimuli within the same session and between the clinical sessions. The ICC values ranged from moderate to excellent.

    CONCLUSIONS: The ABR results from both the LS CE-Chirp® and click stimuli were consistent and reliable over the two clinical sessions suggesting that both stimuli can be used for neurological diagnoses with the same reliability.

  3. Wee SY, Aris AZ, Yusoff FM, Praveena SM
    Sci Rep, 2020 10 20;10(1):17755.
    PMID: 33082440 DOI: 10.1038/s41598-020-74061-5
    Contamination by endocrine disrupting compounds (EDCs) concerns the security and sustainability of a drinking water supply system and human exposure via water consumption. This study analyzed the selected EDCs in source (river water, n = 10) and supply (tap water, n = 155) points and the associated risks. A total of 14 multiclass EDCs was detected in the drinking water supply system in Malaysia. Triclosan (an antimicrobial agent) and 4-octylphenol (a plasticizer) were only detected in the tap water (up to 9.74 and 0.44 ng/L, respectively). Meanwhile, chloramphenicol and 4-nonylphenol in the system were below the method detection limits. Bisphenol A was observed to be highest in tap water at 66.40 ng/L (detection: 100%; median concentration: 0.28 ng/L). There was a significant difference in triclosan contamination between the river and tap water (p 
  4. Hamid FA, Hasbullah AHH, Ban AY
    Breathe (Sheff), 2020 Dec;16(4):200065.
    PMID: 33447285 DOI: 10.1183/20734735.0065-2020
    Can you diagnose this patient with recurrent pneumonia and myasthenia gravis? https://bit.ly/2IBaxC1.
  5. Shafqat SR, Bhawani SA, Bakhtiar S, Ibrahim MNM
    BMC Chem, 2020 Dec;14(1):27.
    PMID: 32266334 DOI: 10.1186/s13065-020-00680-8
    Congo red (CR) is an anionic azo dye widely used in many industries including pharmaceutical, textile, food and paint industries. The disposal of huge amount of CR into the various streams of water has posed a great threat to both human and aquatic life. Therefore, it has become an important aspect of industries to remove CR from different water sources. Molecular imprinting technology is a very slective method to remove various target pollutant from environment. In this study a precipitation polymerization was employed for the effective and selective removal of CR from contaminated aqueous media. A series of congo red molecularly imprinted polymers (CR-MIPs) of uniform size and shape was developed by changing the mole ratio of the components. The optimum ratio (0.1:4: 20, template, functional monomer and cross-linking monomer respectively) for CR1-MIP from synthesized polymers was able to rebind about 99.63% of CR at the optimum conditions of adsorption parameters (contact time 210 min, polymer dosage 0.5 g, concentration 20 ppm and pH 7). The synthesized polymers were characterized by various techniques such as Fourier Infra-red spectroscopy (FTIR), scanning electron microscopy (SEM), Thermogravimetric analysis (TGA), energy-dispersive X-ray spectroscopy (EDX), and Brumauer-Emmett-Teller (BET). The polymer particles have successfully removed CR from different aqueous media with an efficiency of about ~ 90%.
  6. Shafiei SNS, Ahmad K, Ikhsan NFM, Ismail SI, Sijam K
    Braz J Biol, 2020 2 20;81(1):11-17.
    PMID: 32074168 DOI: 10.1590/1519-6984.206124
    Xanthomonas oryzae pv. oryzae (Xoo), a pathogen responsible for rice bacterial leaf blight, produces biofilm to protect viable Xoo cells from antimicrobial agents. A study was conducted to determine the potency of Acacia mangium methanol (AMMH) leaf extract as a Xoo biofilm inhibitor. Four concentrations (3.13, 6.25, 9.38, and 12.5 mg/mL) of AMMH leaf extract were tested for their ability to inhibit Xoo biofilm formation on a 96-well microtiter plate. The results showed that the negative controls had the highest O.D. values from other treatments, indicating the intense formation of biofilm. This was followed by the positive control (Streptomycin sulfate, 0.2 mg/mL) and AMMH leaf extract at concentration 3.13 mg/mL, which showed no significant differences in their O.D. values (1.96 and 1.57, respectively). All other treatments at concentrations of 6.25, 9.38, and 12.5 mg/mL showed no significant differences in their O.D. values (0.91, 0.79, and 0.53, respectively). For inhibition percentages, treatment with concentration 12.5 mg/mL gave the highest result (81.25%) followed by treatment at concentrations 6.25 and 9.38 mg/mL that showed no significant differences in their inhibition percentage (67.75% and 72.23%, respectively). Concentration 3.13 mg/mL resulted in 44.49% of biofilm inhibition and the positive control resulted in 30.75% of biofilm inhibition. Confocal laser scanning microscopy (CLSM) analysis of Xoo biofilm inhibition and breakdown showed the presence of non-viable Xoo cells and changes in aggregation size due to increase in AMMH leaf extract concentration. Control slides showed the absence of Xoo dead cells.
  7. Hasan NAHM, Harith HH, Israf DA, Tham CL
    Mol Biol Rep, 2020 May;47(5):3511-3519.
    PMID: 32279207 DOI: 10.1007/s11033-020-05439-x
    Epithelial-mesenchymal transition (EMT) is one of the mechanisms that contribute to bronchial remodelling which underlie chronic inflammatory airway diseases such as chronic obstructive pulmonary disorder (COPD) and asthma. Bronchial EMT can be triggered by many factors including transforming growth factor β1 (TGFβ1). The majority of studies on TGFβ1-mediated bronchial EMT used BEGM as the culture medium. LHC-9 medium is another alternative available which is more economical but a less common option. Using normal human bronchial epithelial cells (BEAS-2B) cultured in BEGM as a reference, this study aims to validate the induction of EMT by TGFβ1 in cells cultured in LHC-9. Briefly, the cells were maintained in either LHC-9 or BEGM, and induced with TGFβ1 (5, 10 and 20 ng/ml) for 48 h. EMT induction was confirmed by morphological analysis and EMT markers expression by immunoblotting. In both media, cells induced with TGFβ1 displayed spindle-like morphology with a significantly higher radius ratio compared to non-induced cells which displayed a cobblestone morphology. Correspondingly, the expression of the epithelial marker E-cadherin was significantly lower, whereas the mesenchymal marker vimentin expression was significantly higher in induced cells, compared to non-induced cells. By contrast, a slower cell growth rate was observed in LHC-9 compared to that of BEGM. This study demonstrates that neither LHC-9 nor BEGM significantly influence TGFβ1-induced bronchial EMT. However, LHC-9 is less optimal for bronchial epithelial cell growth compared to BEGM. Thus, LHC-9 may be a more cost-effective substitute for BEGM, provided that time is not a factor.
  8. Yaseen ZM, Ali M, Sharafati A, Al-Ansari N, Shahid S
    Sci Rep, 2021 Feb 09;11(1):3435.
    PMID: 33564055 DOI: 10.1038/s41598-021-82977-9
    A noticeable increase in drought frequency and severity has been observed across the globe due to climate change, which attracted scientists in development of drought prediction models for mitigation of impacts. Droughts are usually monitored using drought indices (DIs), most of which are probabilistic and therefore, highly stochastic and non-linear. The current research investigated the capability of different versions of relatively well-explored machine learning (ML) models including random forest (RF), minimum probability machine regression (MPMR), M5 Tree (M5tree), extreme learning machine (ELM) and online sequential-ELM (OSELM) in predicting the most widely used DI known as standardized precipitation index (SPI) at multiple month horizons (i.e., 1, 3, 6 and 12). Models were developed using monthly rainfall data for the period of 1949-2013 at four meteorological stations namely, Barisal, Bogra, Faridpur and Mymensingh, each representing a geographical region of Bangladesh which frequently experiences droughts. The model inputs were decided based on correlation statistics and the prediction capability was evaluated using several statistical metrics including mean square error (MSE), root mean square error (RMSE), mean absolute error (MAE), correlation coefficient (R), Willmott's Index of agreement (WI), Nash Sutcliffe efficiency (NSE), and Legates and McCabe Index (LM). The results revealed that the proposed models are reliable and robust in predicting droughts in the region. Comparison of the models revealed ELM as the best model in forecasting droughts with minimal RMSE in the range of 0.07-0.85, 0.08-0.76, 0.062-0.80 and 0.042-0.605 for Barisal, Bogra, Faridpur and Mymensingh, respectively for all the SPI scales except one-month SPI for which the RF showed the best performance with minimal RMSE of 0.57, 0.45, 0.59 and 0.42, respectively.
  9. Masura SS, Parveez GK, Ti LL
    Plant Physiol Biochem, 2011 Jul;49(7):701-8.
    PMID: 21549610 DOI: 10.1016/j.plaphy.2011.04.003
    We have characterized an oil palm (Elaeis guineensis Jacq.) constitutive promoter that is derived from a translationally control tumor protein (TCTP) gene. The TCTP promoter was fused transcriptionally with the gusA reporter gene and transferred to monocot and dicot systems in order to study its regulatory role in a transient expression study. It was found that the 5' region of TCTP was capable of driving the gusA expression in all the oil palm tissues tested, including immature embryo, embryogenic callus, embryoid, young leaflet from mature palm, green leaf, mesocarp and stem. It could also be used in dicot systems as it was also capable of driving gusA expression in tobacco leaves. The results indicate that the TCTP promoter could be used for the production of recombinant proteins that require constitutive expression in the plant system.
  10. Wang N, Rahman MNBA, Daud MAKBM
    Front Psychol, 2020;11:593063.
    PMID: 33584429 DOI: 10.3389/fpsyg.2020.593063
    In order to improve early childhood physical education, in this study, the talent cultivation mechanism for undergraduates was explored under the "full-practice" concept, oriented by preschooler mental health. First, from the perspective of preschooler psychology, the mechanisms of ability training and talent cultivation for undergraduates majoring in early childhood education were explored under the "full-practice" concept. Considering that the physical, psychological, and intellectual development of preschoolers shall follow the rules of physical education, and current early childhood education mainly focuses on intelligence education in China, early childhood physical education was analyzed further in this study. By investigating the undergraduate majors of early childhood education in Henan University, this study first summarized the current problems in early childhood education systems in universities. Secondly, combined with the form of physical education in kindergartens, strategies for talent cultivation and curriculum setting of early childhood physical education majors in colleges and universities were proposed. Finally, from the perspective of innovation and diversification of training forms, the cultivation of early childhood educators' physical education ability was analyzed at multiple levels and multiple objectives, and the integrated training system of early childhood education talents was constructed. The results show that, among all the courses for early childhood education major, compulsory courses account for 81.2% and optional courses account for 18.8%. In addition, a survey on undergraduates' attitudes toward the curriculum of their major demonstrates that 81.2% of the undergraduates thought that the range and content of practical courses should be increased, indicating that undergraduates majoring in early childhood education are dissatisfied with the current curriculum system, and they have an increased demand for practical courses. Correspondingly, it is vital to build and improve on the early childhood physical education. In terms of its talent cultivation, the "full-practice" concept helps combine theory with practice to improve the effectiveness of education and teaching, pushing forward the reform of the education system. Meanwhile, data- and intelligence-oriented teaching will become the new direction of modern sports development, as well as an important link for tracking and monitoring children's sports teaching in China. Through the continuous introduction of wearable artificial intelligence (AI) products, real-time monitoring of children's physical conditions can be realized, which helps improve the effectiveness of early childhood physical education.
  11. Abdelwahab SI, Abdul AB, Zain ZN, Hadi AH
    Int Immunopharmacol, 2012 Apr;12(4):594-602.
    PMID: 22330084 DOI: 10.1016/j.intimp.2012.01.014
    Interleukin-6 is one of the factors affecting sensitivity to cytotoxic agents. Therefore, the current study was designed to investigate the role of IL-6 and IL6 receptors in the cytotoxic effects of zerumbone in ovarian and cervical cancer cell lines (Caov-3 and HeLa, respectively). Exposure of both cancer cells to zerumbone or cisplatin demonstrated growth inhibition at a dose-dependent manner as determined by the MTT (3-[4,5-dimethylthiazol-2-yl]-2,Sdiphenyltetrazolium bromide) reduction assay. Both laser scanning confocal microscopy and TUNEL assay showed typical apoptotic features in treated cells. The studies conducted seems to suggest that zerumbone induces cell death by stimulating apoptosis better than cisplatin, based on the significantly higher percentage of apoptotic cells in zerumbone's treated cancer cells as compared to cisplatin. In addition, zerumbone and cisplatin arrest cancer cells at G2/M phase as analyzed by flow cytometry. Our results indicated that zerumbone significantly decreased the levels of IL-6 secreted by both cancer cells. In contrast, HeLa and Caov-3 cells were still sensitive to cisplatin and zerumbone, even in the presence of exogenous IL-6. However, membrane-bound IL-6 receptor is still intact after zerumbone treatment as demonstrated using an immune-fluorescence technique. This study concludes that the compound, zerumbone inhibits both cancer cell growth through the induction of apoptosis, arrests cell cycle at G2/M phase and inhibits the secretion levels of IL-6 in both cancer cells. Therefore, zerumbone is a potential candidate as a useful chemotherapeutic agent in treating both cervical and ovarian cancers in future.
  12. Izawati AM, Masani MY, Ismanizan I, Parveez GK
    Front Plant Sci, 2015;6:727.
    PMID: 26442041 DOI: 10.3389/fpls.2015.00727
    DOG(R)1, which encodes 2-deoxyglucose-6-phosphate phosphatase, has been used as a selectable marker gene to produce transgenic plants. In this study, a transformation vector, pBIDOG, which contains the DOG(R)1 gene, was transformed into oil palm embryogenic calli (EC) mediated by Agrobacterium tumefaciens strain LBA4404. Transformed EC were exposed to 400 mg l(-1) 2-deoxyglucose (2-DOG) as the selection agent. 2-DOG resistant tissues were regenerated into whole plantlets on various regeneration media containing the same concentration of 2-DOG. The plantlets were later transferred into soil and grown in a biosafety screenhouse. PCR and subsequently Southern blot analyses were carried out to confirm the integration of the transgene in the plantlets. A transformation efficiency of about 1.0% was obtained using DOG(R)1 gene into the genome of oil palm. This result demonstrates the potential of using combination of DOG(R)1 gene and 2-DOG for regenerating transgenic oil palm.
  13. Zaki MRM, Zaid SHM, Zainuddin AH, Aris AZ
    Mar Pollut Bull, 2021 Jan;162:111866.
    PMID: 33256966 DOI: 10.1016/j.marpolbul.2020.111866
    Microplastics receive global attention due to its strong presence in marine and freshwater organisms. Yet, there are few studies on estuarine organisms. This baseline study evaluates the abundance and distribution of microplastics in the gastropods of a tropical estuary in Selangor, Malaysia. The abundance of microplastics ranged from 0.50 to 1.75 particles/g or from 0.25 to 0.88 particles/individual. The variation in microplastic distribution between the upper and lower estuary indicates that the microplastics originated from the urbanised area of the Klang River estuary. Microplastic sizes varied from 30 to 1850 μm, with the majority being between 300 and 1000 μm (57%). Characteristics of microplastics were dominant for fibres (91%) with black colour (50%). Polyethylene-propylene-diene (PE-PDM) and polyester were the main polymer materials. Assessing the contamination of gastropods by microplastics provides insight into the possibility of utilising gastropods as bioindicators that could be used for monitoring and baseline studies.
  14. Klomp DA, Ord TJ, Das I, Diesmos A, Ahmad N, Stuart-Fox D
    J Evol Biol, 2016 Sep;29(9):1689-700.
    PMID: 27234454 DOI: 10.1111/jeb.12908
    Sexual ornamentation needs to be conspicuous to be effective in attracting potential mates and defending territories and indeed, a multitude of ways exists to achieve this. Two principal mechanisms for increasing conspicuousness are to increase the ornament's colour or brightness contrast against the background and to increase the size of the ornament. We assessed the relationship between the colour and size of the dewlap, a large extendible throat-fan, across a range of species of gliding lizards (Agamidae; genus Draco) from Malaysia and the Philippines. We found a negative relationship across species between colour contrast against the background and dewlap size in males, but not in females, suggesting that males of different species use increasing colour contrast and dewlap size as alternative strategies for effective communication. Male dewlap size also increases with increasing sexual size dimorphism, and dewlap colour and brightness contrast increase with increasing sexual dichromatism in colour and brightness, respectively, suggesting that sexual selection may act on both dewlap size and colour. We further found evidence that relative predation intensity, as measured from predator attacks on models placed in the field, may play a role in the choice of strategy (high chromatic contrast or large dewlap area) a species employs. More broadly, these results highlight that each component in a signal (such as colour or size) may be influenced by different selection pressures and that by assessing components individually, we can gain a greater understanding of the evolution of signal diversity.
  15. Ahmadu T, Ahmad K, Ismail SI, Rashed O, Asib N, Omar D
    Braz J Biol, 2020 11 12;81(4):1007-1022.
    PMID: 33175006 DOI: 10.1590/1519-6984.233173
    Drawbacks associated with the use of chemical fungicides to control plant pathogenic fungi such as Botrytis cinerea stimulate the need for alternatives. Therefore, the present study was carried out to determine the antifungal potentials of Moringa oleifera extracts against B. cinerea. Phytochemical analysis using qualitative chemical tests revealed the presence of huge amount of crucial phytochemicals compounds like phenolic compounds, alkaloids and saponins in the M. oleifera leaf extract. Antifungal bioassay of the crude extracts indicated better mycelial growth inhibition by methanol leaf extract (99%). The minimum inhibitory concentration (MIC) was 5 mg/ml with 100% spore germination inhibition and minimum fungicidal concentration (MFC) was 10 mg/ml with 98.10% mycelial growth inhibition using broth micro dilution and poisoned food techniques. Gas chromatography-mass spectrometry (GC-MS) analysis led to the identification of 67 volatile chemical compounds in the leaf extract with 6-decenoic acid (Z)- (19.87%) was the predominant compound. Further chemical elucidation of the crude extracts performed by liquid chromatography with tandem mass spectrometry (LC-MS/MS) showed the presence of non-volatile chemical compounds, mostly flavones, flavonoids and phenolic acids (i.e. quercetin and kaempferol). Scanning electron microscopy and transmission electron microscopy analysis showed positive effect of M. oleifera leaf extract on the treated conidia and mycelium of B. cinerea. Findings revealed that irreversible surface and ultra-structural changes with severe detrimental effects on conidia and mycelium morphology compared to control treatment. Overall findings suggested that M. oleifera leaf extract is a promising candidate for biological control of fungal pathogens, thus limiting overdependence on chemical fungicides.
  16. Alfizah H, Rukman AH, Norazah A, Hamizah R, Ramelah M
    World J Gastroenterol, 2013 Feb 28;19(8):1283-91.
    PMID: 23483193 DOI: 10.3748/wjg.v19.i8.1283
    To characterise the cag pathogenicity island in Helicobacter pylori (H. pylori) isolates by analysing the strains' vacA alleles and metronidazole susceptibilities in light of patient ethnicity and clinical outcome.
  17. Mustapha MA, Shahpudin SN, Aziz AA, Ankathil R
    World J Gastroenterol, 2012 Jun 7;18(21):2668-73.
    PMID: 22690076 DOI: 10.3748/wjg.v18.i21.2668
    To investigate the allele and genotype frequencies and associated risk of interleukin (IL)-8 -251T>A polymorphism on colorectal cancer (CRC) susceptibility risk.
  18. Nagapan TS, Lim WN, Basri DF, Ghazali AR
    Exp Anim, 2019 Nov 06;68(4):541-548.
    PMID: 31243189 DOI: 10.1538/expanim.19-0017
    Dietary antioxidant supplements such as L-glutathione have gained considerable attention in dermatology and cosmeceutical fields. L-glutathione possesses antiaging, antimelanogenic, antioxidant, and anticancer properties. This study aimed to investigate the inhibitory effects of L-glutathione on melanogenesis activity and oxidative stress in ultraviolet B (UVB)-irradiated BALB/c mice. Eighteen female BALB/c mice were randomly divided into 3 groups: a control group (n=6), a group without UVB irradiation and L-glutathione administration; a UVB irradiated group (n=6), a group irradiated with a UVB dose of 250 mJ/cm2 for 3 min; and a treatment group (n=6), a group irradiated with UVB and treated with 100 mg/kg of L-glutathione by oral gavage. Treatment was given for 14 days, and UVB irradiation was given on days 9, 11, and 13. Oral L-glutathione significantly (P<0.05) reduced lipid peroxidation and elevated superoxide dismutase activity the and glutathione level. L-glutathione also inhibited melanin content and tyrosinase activity significantly (P<0.05) as compared with the UVB-irradiated group. Histopathological examination also showed that L-glutathione reduced the deposition of melanin pigment in the basal layer of the epidermis as compared with that in UVB-irradiated mice. All in all, the present study demonstrated that L-glutathione has the potential to be developed as a photoprotection agent against UVB-induced oxidative stress and melanogenesis.
  19. Muzaini K, Yasin SM, Ismail Z, Ishak AR
    Front Public Health, 2021;9:646790.
    PMID: 33763402 DOI: 10.3389/fpubh.2021.646790
    Background: Sewage workers have a higher risk of exposure to various potential occupational respiratory hazards found in sewage plants. Although previous studies discuss occupational respiratory hazard concentration impacting sewage workers' respiratory health, the results are scarce and mixed. Hence, there is a need to identify the potential respiratory hazards in sewage plants so as to clarify the short- and long-term respiratory health effects. Therefore, this systematic review (SR) aims to critically review previous studies investigating potential respiratory hazards found at sewage plants and their effects on sewage workers' respiratory health. Methods: An SR was conducted using PubMed, EBSCO Medline, Web of Science, Scopus, and Google Scholar on peer-reviewed studies published between January 1994 and October 2020 evaluating the impact of potential exposure to respiratory hazards and its effects on respiratory health among sewage workers. "Sewage treatment plant," "respiratory hazards," and "respiratory health effects" were the three main search terms chosen in this SR. The inclusion criteria were (1) studies on potential occupational respiratory hazard exposure among sewage workers, (2) manuscripts written in English, and (3) studies published in the peer-reviewed literature. The human observational studies' quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Results: We identified 5,660 articles through an initial database search. Only 26 items met the inclusion criteria and were included in this review; 15 human observational studies and 11 environmental assessment studies were conducted in the sewage industries. Most of the human observational studies were rated as moderate quality, two studies were rated as weak quality, and one study with strong quality was identified. Hydrogen sulfide, bioaerosols, particulate matter 2.5 (PM 2.5), and volatile organic compounds (VOC) were found to be potential respiratory hazards. Most of the risks contributed to adverse outcomes on the sewage workers' respiratory health with some inconsistent findings on the relationship between respiratory hazard exposure and respiratory health effects. Conclusion: Our review finds that, although this area is of great importance, quality studies are still lacking. There is a need for additional studies to clarify the effects of respiratory hazard exposure on sewage workers and respiratory health, especially PM 2.5 and VOC.
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