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A Limited Survey of Aflatoxins and Zearalenone in Feed and Feed Ingredients from Pakistan

Iqbal SZ, Asi MR, Nisar S, Zia KM, Jinap S, Malik N

J Food Prot, 2016 Oct;79(10):1798-1801.
PMID: 28221839 DOI: 10.4315/0362-028X.JFP-16-091

This work presents current information on the presence of aflatoxins (AFs) and zearalenone (ZEN) in feed and feed ingredients from Punjab, Pakistan. The 105 samples tested were concentrated feed, i.e., cotton seed meal (18 samples) and soybean meal (14), and feed ingredients, i.e., crushed corn (17), crushed wheat (15), barley (17). and poultry feed (24). Samples were analyzed using high-performance liquid chromatography equipped with a fluorescence detector. Analysis revealed that 69 of 105 samples were contaminated with AFs, and the highest mean concentrations of AFB1 (6.20 μg/kg) and total AFs (9.30 μg/kg) were found in poultry feed samples. The mean total AF concentrations ranged from the limit of quantification to 165.5 μg/kg. However, 75 of the 105 samples were positive for ZEN. The highest mean concentration (19.45 μg/kg) was found in poultry feed samples. The mean ZEN concentrations were 0.15 to 145.30 μg/kg. The prevalence of AFs and ZEN was high in feed and feed ingredients and needs urgent attention.
Examining clinical pharmacist interventions and identifying opioid medication-related issues in patients with cancer

Anwar A, Malik N, Siddiqui A, Shrestha S, Bhutta OA, Mazhar S, et al.

J Oncol Pharm Pract, 2024 Aug 28.
PMID: 39196917 DOI: 10.1177/10781552241279027

INTRODUCTION: Opioid medications are crucial for managing pain among patients with cancer. Yet, inappropriate prescribing and medication issues can compromise patient safety and quality of care. Clinical pharmacists play a significant role in optimizing opioid therapy and addressing issues related to opioid medication use.
OBJECTIVES: This study aimed to examine clinical pharmacist interventions and identify opioid medication-related issues in patients with cancer.
METHOD: We conducted a retrospective observational study at Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, conducting a chart review from 1st July 2021 to 31st December 2021.
RESULTS: Out of 10,534 opioid medication orders, we documented a total of 974 interventions based on our inclusion criteria. Tramadol and morphine accounted for most of these interventions, comprising 49.27% (n = 475) and 40.04% (n = 386), respectively. Regarding clinical significance, 41.70% (n = 406) were deemed significant, while 37.36% (n = 365) were somewhat significant. The majority of interventions, i.e., 54.05% (n = 521), primarily aimed at optimizing patient outcomes, followed by a secondary aim of improvements in communication, i.e., 25.52% (n = 246).
CONCLUSION: This study establishes the evaluation of clinical pharmacist interventions on opioid medication use in patients with cancer, an issue particularly in oncology settings in Pakistan. The findings emphasize the crucial role of clinical pharmacists in addressing issues related to opioid issue medications, thus improving patient safety and optimizing opioid use for patient well-being.
Oral Health Interventions Using Chlorhexidine-Effects on the Prevalence of Oral Opportunistic Pathogens in Stroke Survivors: A Randomized Clinical Trial

Ab Malik N, Abdul Razak F, Mohamad Yatim S, Lam OLT, Jin L, Li LSW, et al.

J Evid Based Dent Pract, 2018 06;18(2):99-109.
PMID: 29747810 DOI: 10.1016/j.jebdp.2017.08.002

OBJECTIVE: To evaluate the presence of oral opportunistic pathogens among stroke survivors, both before and after oral health care interventions.
METHODS: A multicenter randomized clinical trial was conducted on hospitalized stroke survivors. Those in the control group were given standard care of oral hygiene (a manual toothbrush and toothpaste), whereas those in the test group were given intense care of oral hygiene (a powered toothbrush and 1% chlorhexidine oral gel). Oral clinical assessments were carried out, and microbiological samples were collected, using concentrated oral rinse samples at 3 time points: baseline, 3 months, and 6 months.
RESULTS: The prevalence of oral yeast was significantly reduced in the test group at 6 months (P < .05), but no significant difference was observed over time. A significant reduction was observed in the prevalence of Staphylococcus aureus (P < .01) and aerobic and facultative gram-negative bacilli over time (P < .05), but there were no significant differences noted between groups at 6 months. Candida albicans and Klebsiella pneumoniae were the prominent pathogens determined throughout the trial. Kluyvera strains have also been isolated from this cohort.
CONCLUSION: Oral hygiene intervention using a powered tooth brush and 1% chlorhexidine oral gel was effective in reducing the prevalence of oral opportunistic pathogens.
Biomedical waste management associated with infectious diseases among health care professionals in apex hospitals of a typical south asian city

Nosheen F, Malik N, Mehmood Z, Jabeen F, Mahmood A, Ibrahim M, et al.

Environ Res, 2022 Dec;215(Pt 2):114240.
PMID: 36103930 DOI: 10.1016/j.envres.2022.114240

Biomedical waste from healthcare activities poses a higher hazard of infection and damage than other types of trash. The main objective of the study was to assess the awareness knowledge and practices of biomedical waste management (BMWM) among health care professionals in the health care units. The cross-sectional study was carried out to access the awareness, knowledge and practices of health care professionals for BMWM. Using a qualitative approach, the study was escorted in two Apex hospitals i.e. the Allied Hospital and the District Head Quarter Hospital, Faisalabad, Pakistan from August 5, 2019 to October 15, 2019. More than 90% of respondents knew the phrase BMWM, but just 35.4% had awareness about biomedical waste regulations. About 71.6% of the respondents were familiar with biomedical waste's color-coding segregation. The study concludes gap in the awareness, knowledge and practices for BMWM. The sanitary workers of the hospitals had no knowledge about BMWM and the BMWM/healthcare waste management rule 2005 established in Pakistan due to the lack of training regarding waste management and the segregation process. Some of the staff members were aware of the BMWM practices under the rules and regulations of Pakistan but were unable to implement at their work place. It is necessary to dispose of the biomedical waste according to the established terms and conditions of BMWM rules (2005) of Pakistan. Weak structure of BMWM was observed at the study sites due to the lack of training, liabilities and absence of penalties against improper biomedical waste disposal as violation of the rules and regulations. It's a dire need of the time to consider the biomedical waste as hazardous waste and make policies for its safe disposal and ensure the implementation of the policies in all the medical centers of Pakistan.
ORAL HEALTH AND VITAMIN D IN ADULT - A SYSTEMATIC REVIEW

Ab Malik N, Mohamad Yatim S, Mokhtar KN, Md Ramli SNR, Dissanayaka WL, Pelekos G, et al.

Br J Nutr, 2022 Apr 13.
PMID: 35416136 DOI: 10.1017/S0007114522000964

This systematic review aimed to provide a synthesis of the evidence relating to how the provision of Vitamin D supplements influences oral health status. An electronic database search was performed across six databases using a standardised search strategy. The PICO framework was used to define the review question. The screening and selection followed PRISMA process. The quality of reporting was assessed using CONSORT guidelines, and the bias was assessed using the revised Cochrane tool RoB2. A total of 1812 studies were retrieved. 1427 studies were excluded due to unmet inclusion criteria. Full texts of 75 potential studies were retrieved and ultimately six studies met the inclusion criteria. There were limitations in the quality of reporting of studies (between 49% and 73%). 70% of the risk of bias items were in the low risks category. Vitamin D interventions varied with respect to dosage and duration. Qualitative syntheses identified significantly better oral health outcomes. Heterogeneity of study design, intervention and outcomes precluded quantitative synthesis. Few clinical trials investigated the effect of Vitamin D supplementation on oral health. There is considerable heterogeneity among studies interventions and oral health outcomes. Quality of reporting of studies have limitations and there is evidence of study biases. Nonetheless, qualitative synthesis of the evidence suggest that Vitamin D supplements improve oral health outcomes, particularly periodontal health. Calcium may also play a significant role. Further high-quality trials are required of comparable Vitamin D supplements with similar oral health outcomes focus to inform quantitative synthesis of the evidence.
Fulltext Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

N Fountoulakis K, N Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, et al.

Soc Psychiatry Psychiatr Epidemiol, 2023 Sep;58(9):1387-1410.
PMID: 36867224 DOI: 10.1007/s00127-023-02438-8

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak.
MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively.
STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables.
RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p