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  1. Noordin MAM, Noor MM, Aizat WM
    Mini Rev Med Chem, 2020;20(13):1287-1299.
    PMID: 32348218 DOI: 10.2174/1389557520666200429101942
    It is expected that in 2050, there will be more than 20% of senior citizens aged over 60 years worldwide. Such alarming statistics require immediate attention to improve the health of the aging population. Since aging is closely related to the loss of antioxidant defense mechanisms, this situation eventually leads to numerous health problems, including fertility reduction. Furthermore, plant extracts have been used in traditional medicine as potent antioxidant sources. Although many experiments had reported the impact of various bioactive compounds on aging or fertility, there is a lack of review papers that combine both subjects. In this review, we have collected and discussed various bioactive compounds from 26 different plant species known to affect both longevity and fertility. These compounds, including phenolics and terpenes, are mostly involved in the antioxidant defense mechanisms of diverse organisms such as rats, mites, fruit flies, roundworms, and even roosters. A human clinical trial should be considered in the future to measure the effects of these bioactive compounds on human health and longevity. Ultimately, these plant-derived compounds could be developed into health supplements or potential medical drugs to ensure a healthy aging population.
  2. Karlson CKS, Mohd-Noor SN, Nolte N, Tan BC
    Plants (Basel), 2021 Sep 29;10(10).
    PMID: 34685863 DOI: 10.3390/plants10102055
    RNA-guided genomic transcriptional regulation tools, namely clustered regularly interspaced short palindromic repeats interference (CRISPRi) and CRISPR-mediated gene activation (CRISPRa), are a powerful technology for gene functional studies. Deriving from the CRISPR/Cas9 system, both systems consist of a catalytically dead Cas9 (dCas9), a transcriptional effector and a single guide RNA (sgRNA). This type of dCas9 is incapable to cleave DNA but retains its ability to specifically bind to DNA. The binding of the dCas9/sgRNA complex to a target gene results in transcriptional interference. The CRISPR/dCas9 system has been explored as a tool for transcriptional modulation and genome imaging. Despite its potential applications and benefits, the challenges and limitations faced by the CRISPR/dCas9 system include the off-target effects, protospacer adjacent motif (PAM) sequence requirements, efficient delivery methods and the CRISPR/dCas9-interfered crops being labeled as genetically modified organisms in several countries. This review highlights the progression of CRISPR/dCas9 technology as well as its applications and potential challenges in crop improvement.
  3. Ismail NA, Kasim MM, Noor Aizuddin A, Umar NA
    Gynecol Endocrinol, 2013 Jul;29(7):691-4.
    PMID: 23772780 DOI: 10.3109/09513590.2013.797398
    OBJECTIVE: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.
    METHODS: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.
    RESULTS: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07 ± 2.44 versus 2.08 ± 1.12; p = 0.001) and fasting insulin (16.76 ± 8.63 µIU/L versus 10.15 ± 5.07 µIU/L; p = 0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74-0.84) with optimum cut-off value of 2.92 (sensitivity = 63.5%; specificity = 89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p = 0.02) and Cesarean section (p = 0.04) in GDM mothers.
    CONCLUSIONS: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.
  4. Hafizzi Awang NMS, Mohd Noor R, Ramli R, Abdullah B
    Gulf J Oncolog, 2022 Jan;1(38):78-81.
    PMID: 35156648
    BACKGROUND: The infratemporal fossa poses a great challenge to surgeons due to its complex anatomy and communications to many surrounding areas. The disorders that arise from this area can be infections and neoplasms. They can cause varieties of complications due to the extension of the pathologies and compression effect to the other adjacent structures. Inflammatory pseudotumor of the infratemporal fossa is one of the rare disorders of the head and neck.

    CASE PRESENTATION: We report a patient with a pseudotumor of infratemporal fossa that extends to the orbital area and cavernous sinus, causing orbital apex syndromes. The diagnostic imaging, different surgical approaches of the biopsy and methods of treatment of this case are discussed.

    DISCUSSION AND CONCLUSION: Radiological imaging and immunohistopathology are essential in establishing the diagnosis and determine the complications. The surgeons must well understand the characteristics and the impact of the disorders on the adjacent structure and give prompt decision to provide definitive treatments.

  5. Myat-Htun M, Mohd Noor AF, Kawashita M, Baba Ismail YM
    J Mech Behav Biomed Mater, 2022 Feb 07;128:105122.
    PMID: 35168129 DOI: 10.1016/j.jmbbm.2022.105122
    Dense iron-doped akermanite ceramics with 0.3, 0.6 and 0.9 mol% of Fe3+ were synthesized via high-speed planetary ball milling and subsequently subjected to sintering at 1200 and 1250 °C. The aim of the current work was to investigate the effect of trivalent iron (Fe3+) in tuning the physicomechanical and in vitro biological properties of akermanite. The incorporation of Fe3+ into akermanite host and sintering at a high temperature of 1200 °C resulted in a synergistic effect in enhancing the sinterability and densification of akermanite ceramics. Although varying the Fe3+ content, it was found that similar densification and mechanical properties (i.e., diametral tensile strength, Vickers microhardness and fracture toughness) were observed for the doped ceramics at 1250 °C, indicating that this newly developed formulation is temperature-dependent. Fe3+-doped akermanite ceramics revealed greater in vitro bioactivity as compared to undoped akermanite, demonstrated by better coverage of needle-like apatite precipitates after 21 days of immersion in simulated body fluid. Additionally, Rat-1 cells cultured in direct contact with Fe3+-doped akermanite ceramics showed almost double levels of cell proliferation than their undoped counterpart on both 3 and 7 days of culture. Our finding suggests that 0.9Fe-AK ceramic is a suitable formulation to be considered for future bone substitute material as it provides sufficient mechanical strength as well as good bioactivity and the ability to encourage cell proliferation.
  6. Ahmad RS, Sulaiman Z, Nik Hussain NH, Mohd Noor N
    BMC Pregnancy Childbirth, 2022 Jan 31;22(1):85.
    PMID: 35100980 DOI: 10.1186/s12884-021-04304-4
    BACKGROUND: Breastfeeding practice is influenced by the mother's attitude toward and knowledge of breastfeeding. Working mothers face many challenges and need support to maintain breastfeeding. This study aimed to explore working mothers' breastfeeding experiences and challenges that can influenced their practices.

    METHODS: The qualitative phenomenological approach involving working mothers in Kota Bharu who fulfilled the inclusion criteria and consented to participate in the study were recruited using purposive sampling. Sixteen participants aged 24 to 46 years were interviewed using semi-structured in-depth interviews in the study. All interviews were recorded in digital audio, transcribed verbatim and analyzed using thematic analysis.

    FINDINGS: Three main themes emerged from the data analysis: perception of breastfeeding, challenges in breastfeeding, and support for breastfeeding. Two subthemes for perceptions were perception towards breastfeeding and towards infant formula. Challenges had two subthemes too which were related to perceived insufficient milk and breastfeeding difficulty. Where else, two subthemes for support were internal support (spouse and family) and external support (friends, employer, and healthcare staff).

    CONCLUSIONS: Maintaining breastfeeding after return to work is challenging for working mothers and majority of them need support to continue breastfeeding practice. Support from their spouses and families' influences working mothers' decision to breastfeed. Employers play a role in providing a support system and facilities in the workplace for mothers to express and store breast milk. Both internal and external support are essential for mothers to overcome challenges in order to achieve success in breastfeeding.

  7. Nordin N, Zainol Z, Mohd Noor MH, Chan LF
    Artif Intell Med, 2022 10;132:102395.
    PMID: 36207078 DOI: 10.1016/j.artmed.2022.102395
    BACKGROUND: Early detection and prediction of suicidal behaviour are key factors in suicide control. In conjunction with recent advances in the field of artificial intelligence, there is increasing research into how machine learning can assist in the detection, prediction and treatment of suicidal behaviour. Therefore, this study aims to provide a comprehensive review of the literature exploring machine learning techniques in the study of suicidal behaviour prediction.

    METHODS: A search of four databases was conducted: Web of Science, PubMed, Dimensions, and Scopus for research papers dated between January 2016 and September 2021. The search keywords are 'data mining', 'machine learning' in combination with 'suicidal behaviour', 'suicide', 'suicide attempt', 'suicidal ideation', 'suicide plan' and 'self-harm'. The studies that used machine learning techniques were synthesized according to the countries of the articles, sample description, sample size, classification tasks, number of features used to develop the models, types of machine learning techniques, and evaluation of performance metrics.

    RESULTS: Thirty-five empirical articles met the criteria to be included in the current review. We provide a general overview of machine learning techniques, examine the feature categories, describe methodological challenges, and suggest areas for improvement and research directions. Ensemble prediction models have been shown to be more accurate and useful than single prediction models.

    CONCLUSIONS: Machine learning has great potential for improving estimates of future suicidal behaviour and monitoring changes in risk over time. Further research can address important challenges and potential opportunities that may contribute to significant advances in suicide prediction.

  8. Singh Randhawa A, Mohd Noor N, Md Daud MK, Abdullah B
    Front Pharmacol, 2021;12:731201.
    PMID: 35082662 DOI: 10.3389/fphar.2021.731201
    Bilastine is a non-sedating second generation H1 oral antihistamine (OAH) for treating allergic rhinitis (AR) patients. The effect of bilastine has not previously been evaluated in a meta-analysis. The aim of this review was to determine the efficacy and safety of bilastine in treating AR. An electronic literature search was performed using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Direct and Google Scholar up to March 2021. Randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy were included. The included studies must have diagnosis of AR established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period. The primary outcomes assessed were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QOL) and adverse events. The risk of bias and quality of evidence for all studies were appraised. The meta-analysis was done using Review Manager 5.3 software based on the random-effects model. The search identified 135 records after removal of duplicates. Following screening and review of the records, fifteen full-text articles were assessed for eligibility. Five trials involving 3,329 patients met the inclusion criteria. Bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QOL but has comparable efficacy with other OAHs in TSS, NSS, NNS, rhinitis discomfort score and QOL. There was no difference in adverse effects when bilastine was compared against placebo and other OAHs except for somnolence. Bilastine has fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality. Bilastine is effective and safe in treating the overall symptoms of AR with comparable efficacy and safety with other OAHs except somnolence. Whilst bilastine has similar efficacy to cetirizine, somnolence is notably less in bilastine.
  9. Noor NM, Umar S, Abdul-Aziz A, Sheikh K, Somavarapu S
    Bioengineering (Basel), 2022 Jan 01;9(1).
    PMID: 35049720 DOI: 10.3390/bioengineering9010011
    Male pattern baldness (MPB) is a common condition that has a negative impact on the psycho-social health of many men. This study aims to engineer an alcohol-free formulation to cater for individuals who may have had allergic reactions to alcohol-based preparations. A lipid-based nanoparticle system composed of stearic and oleic acid (solid and liquid lipid) was used to deliver dutasteride (DST) for topical application. Two compositions, with oleic acid (Formulation A) and without (Formulation B), were compared to analyse the role of oleic acid as a potential active ingredient in addition to DST. DST-loaded LNP were prepared using the emulsification-ultrasonication method. All of the prepared formulations were spherical in shape in the nanometric size range (150-300 nm), with entrapment efficiencies of >75%. X-ray diffractograms revealed that DST exists in an amorphous form within the NLP matrices. The drug release behaviour from both LNP preparations displayed slow release of DST. Permeation studies through pig ear skin demonstrated that DST-LNP with oleic acid produced significantly lower permeation into the dermis compared to the formulation without oleic acid. These results suggest that the proposed formulation presents several characteristics which are novel, indicating its suitability for the dermal delivery of anti-androgenic molecules.
  10. Ramli NAS, Mohd Noor MA, Musa H, Ghazali R
    J Sci Food Agric, 2018 Jul;98(9):3351-3362.
    PMID: 29250790 DOI: 10.1002/jsfa.8839
    BACKGROUND: Palm oil is one of the major oils and fats produced and traded worldwide. The value of palm oil products is mainly influenced by their quality. According to ISO 17025:2005, accredited laboratories require a quality control procedure with respect to monitoring the validity of tests for determination of quality parameters. This includes the regular use of internal quality control using secondary reference materials. Unfortunately, palm oil reference materials are not currently available. To establish internal quality control samples, the stability of quality parameters needs to be evaluated.

    RESULTS: In the present study, the stability of quality parameters for palm oil products was examined over 10 months at low temperature storage (6 ± 2 °C). The palm oil products tested included crude palm oil (CPO); refined, bleached and deodorized (RBD) palm oil (RBDPO); RBD palm olein (RBDPOo); and RBD palm stearin (RBDPS). The quality parameters of the oils [i.e. moisture content, free fatty acid content (FFA), iodine value (IV), fatty acids composition (FAC) and slip melting point (SMP)] were determined prior to and throughout the storage period. The moisture, FFA, IV, FAC and SMP for palm oil products changed significantly (P  0.05). The stability study indicated that the quality of the palm oil products was stable within the specified limits throughout the storage period at low temperature.

    CONCLUSION: The storage conditions preserved the quality of palm oil products throughout the storage period. These findings qualify the use of the palm oil products CPO, RBDPO, RBDPOo and RBDPS as control samples in the validation of test results. © 2017 Society of Chemical Industry.

  11. Tavakoli Z, Montazeri A, Farshad AA, Lotfi Z, Noor Hassim I
    Glob J Health Sci, 2016 May 18;9(1):57870.
    PMID: 27530574 DOI: 10.5539/gjhs.v9n1p120
    Physicians are at risk of having high levels of stress which affect their performance. Finding the stressors and the coping skills to manage stress could be used to develop program to decrease stressful situation. No study has been done on Physicians' stress and coping in Iran. The main objective of this study is to find out the main stressors and coping strategies among Iranian Physicians working in hospital in Tehran-Iran.
  12. Lee ZY, Noor Airini I, Barakatun-Nisak MY
    Clin Nutr, 2018 08;37(4):1264-1270.
    PMID: 28599979 DOI: 10.1016/j.clnu.2017.05.013
    BACKGROUND & AIMS: The effect of provision of full feeding or permissive underfeeding on mortality in mechanically ventilated critically ill patients in the intensive care unit (ICU) is still controversial. This study investigated the relationship of energy and protein intakes with 60-day mortality, and the extent to which ICU length of stay and nutritional risk status influenced this relationship.

    METHODS: This is a prospective observational study conducted among critically ill patients aged ≥18 years, intubated and mechanically ventilated within 48 h of ICU admission and stayed in the ICU for at least 72 h. Information on baseline characteristics and nutritional risk status (the modified Nutrition Risk in Critically ill [NUTRIC] score) was collected on day 1. Nutritional intake was recorded daily until death, discharge, or until the twelfth evaluable days. Mortality status was assessed on day 60 based on the patient's hospital record. Patients were divided into 3 groups a) received <2/3 of prescribed energy and protein (both <2/3), b) received ≥2/3 of prescribed energy and protein (both ≥2/3) and c) either energy or protein received were ≥2/3 of prescribed (either ≥2/3). The relationship between the three groups with 60-day mortality was examined by using logistic regression with adjustment for potential confounders. Sensitivity analysis was performed to examine the influence of ICU length of stay (≥7 days) and nutritional risk status.

    RESULTS: Data were collected from 154 mechanically ventilated patients (age, 51.3 ± 15.7 years; body mass index, 26.5 ± 6.7 kg/m2; 54% male). The mean modified NUTRIC score was 5.7 ± 1.9, with 56% of the patients at high nutritional risk. The patients received 64.5 ± 21.6% of the amount of energy and 56.4 ± 20.6% of the amount of protein prescribed. Provision of energy and protein at ≥2/3 compared with <2/3 of the prescribed amounts was associated with a trend towards increased 60-day mortality (Adjusted odds ratio [Adj OR] 2.23; 95% confidence interval [CI], 0.92-5.38; p = 0.074). No difference in mortality status was found between energy and protein provision at either ≥2/3 compared with <2/3 of the prescribed amounts (Adj OR 1.61, 95% CI, 0.58-4.45; p = 0.357). Nutritional risk status, not ICU length of stay, influenced the relationship between nutritional adequacy and 60-day mortality.

    CONCLUSIONS: Energy and protein adequacy of ≥2/3 of the prescribed amounts were associated with a trend towards increased 60-day mortality among mechanically ventilated critically ill patients. However, neither energy nor protein adequacy alone at ≥ or <2/3 adequacy affect 60-day mortality. Increased mortality was associated with provision of energy and protein at ≥2/3 of the prescribed amounts, which only affected patients with low nutritional risk.

  13. Hisham S, Flavel A, Abdullah N, Noor MHM, Franklin D
    Forensic Sci Int, 2018 Mar;284:78-84.
    PMID: 29353220 DOI: 10.1016/j.forsciint.2017.12.046
    Timing of fusion of the spheno-occipital synchondrosis (SOS) is correlated with age. Previous research, however, has demonstrated variation in the timing of closure among different global populations. The present study aims to quantify the timing of SOS fusion in Malaysian individuals as visualised in multi-detector computed tomography (CT) scans and to thereafter formulate age estimation models based on fusion status. Anonymised cranial CT scans of 336 males and 164 females, aged 5-25 years, were acquired from the National Institute of Forensic Medicine, Hospital Kuala Lumpur and Department of Diagnostic Imaging, Hospital Sultanah Aminah. The scans were received in DICOM format and reconstructed into three-dimensional images using OsiriX. The SOS is scored as open, fusing endocranially, fusing ectocranially or completely fused. Statistical analyses are performed using IBM SPSS Statistics version 24. Transition analysis (Nphases2) is then utilised to calculate age ranges for each stage. To assess the reliability of an observation, intra- and inter-observer agreement is quantified using Fleiss Kappa and was found to be excellent (κ=0.785-0.907 and 0.812). The mean (SD) age for complete fusion is 20.84 (2.84) years in males and 19.78 (3.35) years in females. Transition ages between Stages 0 and 1, 1 and 2, and 2 and 3 in males are 12.52, 13.98 and 15.52 years, respectively (SD 1.37); in females, the corresponding data are 10.47, 12.26 and 13.80 years (SD 1.72). Complete fusion of the SOS was observed in all individuals above the age of 18 years. SOS fusion status provides upper and lower age boundaries for forensic age estimation in the Malaysian sample.
  14. Choi SJ, Lee TH, Noor NM, Kim JJ
    Sci Rep, 2022 Dec 16;12(1):21736.
    PMID: 36526720 DOI: 10.1038/s41598-022-26062-9
    The degree of structural damage is significantly more severe when a blast occurs inside than outside of a structure. However, existing designs for RC structures such as reinforced concrete containment vessels (RCCV) do not include design features to protect the structure for internal blast. Therefore, the internal blast resistance capacity of RC structures is evaluated by performing internal blast tests on RC tubular structures. The main objective of the study was to observe and document the basic structural behavior data obtained from internal detonation tests. ANFO explosive charge weights of 15.88, 20.41, 22.68 and 24.95 kg were selected for a charge detonating at a cross section center of the mid-span of the specimen, giving a standoff distance to the inner wall surface of 1000 mm. The data acquisitions include blast pressure, deflection, strain, and crack pattern. When the explosive charge weight increased from 15.88 to 24.95 kg, the peak incident pressure and time duration increased from 0.1718 to 0.3394 MPa and from 5.856 to 5.981 ms, respectively. Then, the test data were used to predict the internal charge weight required to fail a real scale RCCV using simple assumptions and the test data. The results of the study are discussed in detail in the paper.
  15. Nordin N, Zainol Z, Mohd Noor MH, Chan LF
    Asian J Psychiatr, 2023 Jan;79:103316.
    PMID: 36395702 DOI: 10.1016/j.ajp.2022.103316
    Machine learning approaches have been used to develop suicide attempt predictive models recently and have been shown to have a good performance. However, those proposed models have difficulty interpreting and understanding why an individual has suicidal attempts. To overcome this issue, the identification of features such as risk factors in predicting suicide attempts is important for clinicians to make decisions. Therefore, the aim of this study is to propose an explainable predictive model to predict and analyse the importance of features for suicide attempts. This model can also provide explanations to improve the clinical understanding of suicide attempts. Two complex ensemble learning models, namely Random Forest and Gradient Boosting with an explanatory model (SHapley Additive exPlanations (SHAP)) have been constructed. The models are used for predictive interpretation and understanding of the importance of the features. The experiment shows that both models with SHAP are able to interpret and understand the nature of an individual's predictions with suicide attempts. However, compared with Random Forest, the results show that Gradient Boosting with SHAP achieves higher accuracy and the analyses found that history of suicide attempts, suicidal ideation, and ethnicity as the main predictors for suicide attempts.
  16. Ram SP, Noor AR, Ariffin WA, Ariffin NA
    Singapore Med J, 1994 Apr;35(2):205-7.
    PMID: 7939823
    A 37-week gestation male boy was born to a gravida seven para six mother by spontaneous vertex delivery at home. The baby cried at birth. On day 3 of life, he was admitted for respiratory distress. Physical examination revealed ectrodactyly, thin dry skin, anomalous tear duct with cardiomegaly. X-ray revealed absent radii, cardiomegaly and hemivertebra at L1. Echocardiogram revealed perimembranous type of ventricular septal defect. A diagnosis of Ectodermal Dysplasia Ectrodactyly Clefting Syndrome with ventricular septal defect was made. He was managed conservatively in the nursery. However, he expired on day 27 of life following short spell of fever apnoeic episode due to neonatal sepsis.
  17. Ten SK, Chin YM, Noor PJ, Hassan K
    Singapore Med J, 1990 Aug;31(4):355-9.
    PMID: 2255934
    Cytogenetic investigations were carried out on 117 women with primary amenorrhea who had been referred to our Genetics Laboratory by clinicians throughout Malaysia, after exclusion of other causes of the disorder. Thirty-six cases (31%) showed numerical or structural abnormalities of the sex chromosomes. These can be broadly classified into 4 main types, namely, presence of a Y chromosome (14%), X-chromosome aneuploidies (8%), structural anomalies of the X-chromosome (7%) and lastly, presence of a marker chromosome (2%). Mosaics constituted 17% of the abnormalities observed, always in association with a 45,X cell line. There was no observable correlation between the phenotype of the patients and their respective abnormal karyotypes. The aetiological role of sex chromosomal abnormalities in these amenorrheic women is discussed.
  18. Noor PJ, Chin YM, Ten SK, Hassan K
    Singapore Med J, 1987 Jun;28(3):235-40.
    PMID: 2958941
    A cytogenetic survey 01 124 children in lour special schools for the mentally handicapped was carried out to determine the contribution of chromosomal abnormalities to the aetiology of mental retardation in these children. All the children were karyotyped employing the G·banding technique 01 43 (34.7%) with an abnormal chromosome complement, 40 had Down's Syndrome, and 3 had other chromosomal abnormalities, namely a translocation 1;17, a mosaic male/trisomy 18 and a Klinefelter's syndrome. Polymorphic variants involving chromosomes 1, 9, and 14 were also observed. Two other children showed variants of the Y chromosome (one a small Y and the other a metacentric Y). The possible contribution by these abnormal variants to mental retardation is discussed. Details of the abnormal cytogenetic findings are reported.
  19. Ten SK, Chin YM, Jamilatul Noor MBP, Hassan K
    Singapore Med J, 1985;26(4-5):372-8.
    PMID: 4071092
    An Indian family with all 3 sons having the fragile X syndrome is reported. The frequency of fragile X cells observed ranged from 4·16%. The phenotypically normal mother, although an obligate carrier, did not express any fragile X chromosomes in her Iymphocyte cultures. The range of mental retardation in affected
    hemizygous males and heterozygous females as well as the significance of the fragile X chromosome in prenatal diagnosis are discussed.
  20. Chen CX, Aris A, Yong EL, Noor ZZ
    Environ Sci Pollut Res Int, 2022 Jan;29(4):4787-4802.
    PMID: 34775565 DOI: 10.1007/s11356-021-17365-x
    Many advanced technologies have shown encouraging results in removing antibiotics from domestic wastewater. However, as activated sludge treatment is the most common sewage treatment system employed worldwide, improving its effect on antibiotic removal would be more desirable. Understanding the removal mechanisms, kinetics and factors that affect antibiotic removal in the activated sludge process is important as it would allow us to improve the treatment performance. Although these have been discussed in various literature covering different types of antibiotics and wastewater, a specific review on antibiotics and domestic wastewater is clearly missing. This review paper collates, discusses and analyses the removal of antibiotics from sewage in the activated sludge process along with the removal mechanisms and kinetics. The antibiotics are categorised into six classes: β-lactam, dihydrofolate reductase inhibitor, fluoroquinolone, macrolide, sulfonamides and tetracycline. Furthermore, the factors affecting the system performance with regard to antibiotic removal are examined.
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