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  1. Islam N, Hasan M, Ali SM
    Med J Malaysia, 1977 Jun;31(4):322-5.
    PMID: 927240
  2. Ali SM, Siddiqui R, Khan NA
    J Pharm Pharmacol, 2018 Oct;70(10):1287-1300.
    PMID: 30003546 DOI: 10.1111/jphp.12976
    OBJECTIVES: Whether vertebrates/invertebrates living in polluted environments are an additional source of antimicrobials.

    KEY FINDINGS: Majority of antimicrobials have been discovered from prokaryotes and those which are of eukaryotic origin are derived mainly from fungal and plant sources. With this in mind, it is important to note that pests, such as cockroaches come across pathogenic bacteria routinely, yet thrive in polluted environments. Other animals, such as snakes thrive from feeding on germ-infested rodents. Logically, such species must have developed an approach to protect themselves from these pathogens, yet they have largely been ignored as a potential source of antimicrobials despite their remarkable capability to fight disease-causing organisms.

    SUMMARY: Animals living in polluted environments are an underutilized source for potential antimicrobials, hence it is believed that several novel bioactive molecule(s) will be identified from these sources to counter increasingly resistant bacterial infections. Further research will be necessary in the development of novel antimicrobial(s) from these unusual sources which will have huge clinical impact worldwide.

  3. Manan MM, Ali SM, Khan MA, Jafarian S
    Pak J Pharm Sci, 2015 Sep;28(5):1705-11.
    PMID: 26408891
    Out-of-pocket (OOP) payments may burden Methadone Maintenance Clinic patients. Since treatment is fully subsidized by the government, financial constraint might lead to patients being made to pay or be given incentive for inconvenience of therapy. This study thus evaluates the characteristic and commitment of methadone therapy patient's in terms of OOP cost, Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA) concept. This survey utilizes the questionnaire by Boris ova & Goodman (2003) on the OOP, WTP and WTA. The forty adult patient's selected medical records from year 2009-2011 were from an urban government methadone clinic. Subject's selection was by convenient sampling based on the predetermined criteria. Most were male (95%) and Malay (60%) was the predominant group. Patients were group into three income groups; ≤ RM1000, ≥ RM1000 -≤ RM2000 and ≥ RM3000. The average OOP cost per month was RM391.30 (s.d RM337.50), which is about 35% of employed patient's monthly income. The wide variation could be attributed by high inter-individual and significant differences between patients in terms of transport, times taken to clinic, cost per trip and weekly household income (p=<0.05). Patients with income of less than RM1000 showed the highest tendency to pay for treatment, asked for the least money for inconvenience and many are unwilling to accept any payments. These findings showed that WTP and WTA is less of a concern for patients in the low-income group. To conclude, OOP payment is not a treatment barrier for most of the urban MMT patients.
  4. Ali SM, Siddiqui R, Sagathevan KA, Khan NA
    Folia Microbiol (Praha), 2021 Apr;66(2):285-291.
    PMID: 33704690 DOI: 10.1007/s12223-021-00860-6
    The evolution of multiple-drug resistant bacteria is contributing to the global antimicrobial crisis, hence driving us to search for novel antimicrobial(s). Among animals, invertebrates represent up to 80% of all known species suggesting their wide distribution. Despite their ubiquitous and plentiful nature, they have been largely unexplored as potential source of antibacterials. In this study, we selected a broad range of invertebrates from terrestrial and marine environments and tested their lysates for antibacterial activity against methicillin-resistant Staphylococcus aereus (MRSA) and neuropathogenic Escherichia coli K1. Cockroaches, centipedes, tarantulas, prawns, lobster, and mud crabs showed antibacterial activity with selected lysates exhibiting more than 90% bactericidal effects. The red-headed centipede's hemolymph showed 90% and 50% bacteriostatic activity against MRSA and E. coli K1, respectively. Tarantula's body extracts exhibited antibacterial activity against MRSA and E. coli K1. Gut extracts of tiger prawn exhibited more than 90% bacteriostatic activity against both bacteria. The selected lobster and mud crab extract exhibited up to 90% growth inhibitory activity against MRSA. Overall, these results showed that selected invertebrates are an untapped source of broad-spectrum antibacterial activity and suggest the presence of biologically active molecules.
  5. Ali SM, Khan NA, Sagathevan K, Anwar A, Siddiqui R
    AMB Express, 2019 Jun 28;9(1):95.
    PMID: 31254123 DOI: 10.1186/s13568-019-0816-3
    The discovery of novel antimicrobials from animal species under pollution is an area untapped. Chinese red-headed centipede is one of the hardiest arthropod species commonly known for its therapeutic value in traditional Chinese medicine. Here we determined the antibacterial activity of haemolymph and tissue extracts of red-headed centipede, Scolopendra subspinipes against a panel of Gram-positive and Gram-negative bacteria. Lysates exhibited potent antibacterial activities against a broad range of bacteria tested. Chemical characterization of biologically active molecules was determined via liquid chromatography mass spectrometric analysis. From crude haemolymph extract, 12 compounds were identified including: (1) L-Homotyrosine, (2) 8-Acetoxy-4-acoren-3-one, (3) N-Undecylbenzenesulfonic acid, (4) 2-Dodecylbenzenesulfonic acid, (5) 3H-1,2-Dithiole-3-thione, (6) Acetylenedicarboxylate, (7) Albuterol, (8) Tetradecylamine, (9) Curcumenol, (10) 3-Butylidene-7-hydroxyphthalide, (11) Oleoyl Ethanolamide and (12) Docosanedioic acid. Antimicrobial activities of the identified compounds were reported against Gram-positive and Gram-negative bacteria, fungi, viruses and parasites, that possibly explain centipede's survival in harsh and polluted environments. Further research in characterization, molecular mechanism of action and in vivo testing of active molecules is needed for the development of novel antibacterials.
  6. Munim ZH, Mohammadi M, Shakil MH, Ali SM
    Comput Ind Eng, 2022 Mar;165:107963.
    PMID: 35079195 DOI: 10.1016/j.cie.2022.107963
    Manufacturing firms that continued production activities during the COVID-19 have been taking necessary measures to cope with the risks imposed by the pandemic. This study assesses the measures implemented by the Ready-Made Garments (RMG) sector in Bangladesh. With the increase in COVID-19 cases in Bangladesh, following government order, along with firms in other manufacturing sectors, the RMG firms had to shut-down their production between March 26 and April 25, 2020. Soon after the factories reopened, they had to take necessary actions to ensure employee safety, supply of raw materials, and purchase orders from buyers. Using a semi-structured interview approach, we identify 16 measures that have been implemented in the RMG sector in Bangladesh for the employees, suppliers and buyers. Then, we assess the degree of implementation of these measures using the Bayesian Best-Worst method. We find that providing healthcare safety, bringing previously outsourced activities in-house, and ensuring smooth delivery of existing orders were the three most implemented measures for employees, suppliers and buyers, respectively. On a higher level, the RMG industry professionals prioritised buyer-related measures the most, followed by employee and supplier-related. The analysed measures provide a blueprint for supply chain risk management during future waves of COVID-19 transmission and for other potential large-scale natural disasters.
  7. Manan MM, Ali SM, Khan MA, Jafarian S, Hameed MA
    Pak J Pharm Sci, 2013 Jul;26(4):841-6.
    PMID: 23811468
    This study is an observational cross-sectional study aimed to examine the possible demographic and social characteristics of patients enrolled at the Methadone Maintenance Therapy Adherence Clinic (MMTAC) in Malaysia. Medical records from year 2009 - 2011 were Reviewed. Demographic, social characteristics and laboratory examinations such as age, gender, race, clinic attendances and urine analysis were recorded. Subjects were selected by means of convenient sampling but based on the specified inclusion and exclusion criteria. Data were analyzed by either Chi-square test, Fisher's exact test Mann-Whitney U-test, with the limit of significance was set at p < 0.05. Demographically, this study found that the ratio of Malays, Chinese and Indian enrolled to the MMTAC program is similar to the distribution of races in Malaysia. Their starting age for drug use was between 14-35 years and the age to enrolment between 30-58 years. Socially, many are unemployed, lowly educated and married. Most are drug users with a high percentage of HCV accompanied with impaired liver function. Retention rate was 87% but illicit drug use was at 57.50%. However, percentage of employment increased significantly after therapy. The study managed to identify several demographical and social distributions of patients attending the MMTAC. Although attendance rate was high, many were on illicit drug use. Nevertheless, employment rate improved significantly.
    Study site: government methadone clinic in Klang, Selangor, Malaysia
  8. Kashif M, Ali ME, Ali SM, Hashim U, Hamid SB
    Nanoscale Res Lett, 2013;8(1):68.
    PMID: 23399029 DOI: 10.1186/1556-276X-8-68
    ZnO nanorods were synthesized using a low-cost sol-gel spin coating technique. The synthesized nanorods were consisted of hexagonal phase having c-axis orientation. SEM images reflected perpendicular ZnO nanorods forming bridging network in some areas. The impact of different hydrogen concentrations on the Pd-sensitized ZnO nanorods was investigated using an impedance spectroscopy (IS). The grain boundary resistance (Rgb) significantly contributed to the sensing properties of hydrogen gas. The boundary resistance was decreased from 11.95 to 3.765 kΩ when the hydrogen concentration was increased from 40 to 360 ppm. IS gain curve showed a gain of 6.5 for 360 ppm of hydrogen at room temperature. Nyquist plot showed reduction in real part of impedance at low frequencies on exposure to different concentrations of hydrogen. Circuit equivalency was investigated by placing capacitors and resistors to identify the conduction mechanism according to complex impedance Nyquist plot. Variations in nanorod resistance and capacitance in response to the introduction of various concentrations of hydrogen gas were obtained from the alternating current impedance spectra.
  9. Kamarudin NA, Manan MM, Zulkifly HH, Neoh CF, Ali SM, Ming LC
    Asia Pac J Clin Nutr, 2016;25(1):53-61.
    PMID: 26965762 DOI: 10.6133/apjcn.2016.25.2.02
    This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2.00 (<28 weeks group); 1.00 (28-31 weeks group) and 0.75 (>31 weeks group). Neonates in the <28 weeks group were more likely to receive AA at an earlier time and higher initial dose compared with the other age groups. The study also found that there was no statistically significant difference in the dose of AA on the first day of PN administration and that the significant variations in nutritional parameters among the subjects did not lead to differences in physical outcomes. This study identified that when PN is provided in the local hospital setting, it is likely that the current nutritional practices are inadequate to achieve the standard growth recommendations. Our findings call for a need to optimize AA and calorie intake since growth restriction is a morbidity which will affect the infants' growth and development. Current prescriptions for PN in this hospital need to be reviewed in order to improve patient outcomes.
  10. Ali SM, Siddiqui R, Ong SK, Shah MR, Anwar A, Heard PJ, et al.
    Appl Microbiol Biotechnol, 2017 Jan;101(1):253-286.
    PMID: 27743045 DOI: 10.1007/s00253-016-7872-2
    Infectious diseases remain a significant threat to human health, contributing to more than 17 million deaths, annually. With the worsening trends of drug resistance, there is a need for newer and more powerful antimicrobial agents. We hypothesized that animals living in polluted environments are potential sources of antimicrobials. Under polluted milieus, organisms such as cockroaches encounter different types of microbes, including superbugs. Such creatures survive the onslaught of superbugs and are able to ward off disease by producing antimicrobial substances. Here, we characterized antibacterial properties in extracts of various body organs of cockroaches (Periplaneta americana) and showed potent antibacterial activity in crude brain extract against methicillin-resistant Staphylococcus aureus and neuropathogenic Escherichia coli K1. The size-exclusion spin columns revealed that the active compound(s) are less than 10 kDa in molecular mass. Using cytotoxicity assays, it was observed that pre-treatment of bacteria with lysates inhibited bacteria-mediated host cell cytotoxicity. Using spectra obtained with LC-MS on Agilent 1290 infinity liquid chromatograph, coupled with an Agilent 6460 triple quadruple mass spectrometer, tissues lysates were analysed. Among hundreds of compounds, only a few homologous compounds were identified that contained the isoquinoline group, chromene derivatives, thiazine groups, imidazoles, pyrrole-containing analogs, sulfonamides, furanones, and flavanones and known to possess broad-spectrum antimicrobial properties and anti-inflammatory, anti-tumour, and analgesic properties. Further identification, characterization, and functional studies using individual compounds can act as a breakthrough in developing novel therapeutics against various pathogens including superbugs.
  11. Ali SM, Raman J, Lakshmanan H, Ling TC, Phan CW, Tan YS, et al.
    Int J Med Mushrooms, 2018;20(11):1021-1030.
    PMID: 30806227 DOI: 10.1615/IntJMedMushrooms.2018028307
    Lentinus edodes (shiitake mushroom) has exhibited fibrinolytic activity. We synthesized and characterized selenium nanoparticles (SeNPs) using protein precipitated from the mushroom. We also investigated the fibrinolytic activity of the SeNPs. The proteins from a crude extract of L. edodes were recovered through the use of aqueous 2-phase separation, and these we used as the capping agent in SeNP biosynthesis. We characterized the SeNPs using UV-visible spectrophotometry, field emission scanning electron microscopy (FESEM), energy dispersive X-ray (EDX), transmission electron microscopy (TEM), particle size distribution analysis, and Fourier transform infrared spectroscopy (FT-IR). The fibrinolytic capability of the SeNPs was tested through an in vitro fibrin plate assay. The UV-visible spectra showed maximal absorbance at 220 nm. FESEM images showed that the SeNPs were dispersed and did not clump. The TEM images revealed a spherical shape and average size of the SeNPs. The particle size distribution analysis confirmed the mean size of the SeNPs at 64.53 nm. A strong signal for the presence of selenium was observed in the EDX analysis. The FT-IR spectrum revealed the involvement of protein functional groups in the reduction of sel-enite. Overall, the SeNPs capped with protein from shiitake mushroom were effective as an in vitro fibrinolytic agent.
  12. Ali SM, Sovuthy C, Noghanian S, Ali Z, Abbasi QH, Imran MA, et al.
    Micromachines (Basel), 2021 Apr 22;12(5).
    PMID: 33922053 DOI: 10.3390/mi12050475
    The human body is an extremely challenging environment for wearable antennas due to the complex antenna-body coupling effects. In this article, a compact flexible dual-band planar meander line monopole antenna (MMA) with a truncated ground plane made of multiple layers of standard off-the-shelf materials is evaluated to validate its performance when worn by different subjects to help the designers who are shaping future complex on-/off-body wireless devices. The antenna was fabricated, and the measured results agreed well with those from the simulations. As a reference, in free-space, the antenna provided omnidirectional radiation patterns (ORP), with a wide impedance bandwidth of 1282.4 (450.5) MHz with a maximum gain of 3.03 dBi (4.85 dBi) in the lower (upper) bands. The impedance bandwidth could reach up to 688.9 MHz (500.9 MHz) and 1261.7 MHz (524.2 MHz) with the gain of 3.80 dBi (4.67 dBi) and 3.00 dBi (4.55 dBi), respectively, on the human chest and arm. The stability in results shows that this flexible antenna is sufficiently robust against the variations introduced by the human body. A maximum measured shift of 0.5 and 100 MHz in the wide impedance matching and resonance frequency was observed in both bands, respectively, while an optimal gap between the antenna and human body was maintained. This stability of the working frequency provides robustness against various conditions including bending, movement, and relatively large fabrication tolerances.
  13. Bakar NA, Jayah NI, Mohamed NR, Ali SM, Nasir SH, Hashim R, et al.
    J World Fed Orthod, 2020 03;9(1):3-8.
    PMID: 32672665 DOI: 10.1016/j.ejwf.2019.11.004
    INTRODUCTION: Gingivitis is one of the commonest problems faced by patients with fixed appliances (FA) as there is close relation between the appliances to gingival sulcus. Stichopus horrens (SH) is a sea cucumber from the Indo-Pacific that has medical healing properties which have been traditionally used.

    OBJECTIVE: To assess the effects of toothpaste containing aqueous SH extract on plaque-induced gingivitis following orthodontic bond-up and to identify the optimal concentration of SH.

    METHODS: A single-centred; triple-blinded randomized controlled trial conducted in 40 patients with FA. Participants were randomly assigned to one of the four groups with toothpaste which has concentration of SH extract of 0%, 3%, 6% or 9%. The statistician, the participants and the researchers involved in data collection were kept blinded from the allocation. Gingival Index (GI) and Bleeding on Probing (BOP) for each group were taken at day 0,7,14 and 30.

    RESULTS: 9% of SH-containing toothpaste (SHCT) showed most substantial result as there were significance difference of GI (P = 0.020) from Day 7 to 14 and from Day 0 to 14 (P = 0.020). There was also significance difference of BOP from Day 0 to 14 (P = 0.022) and from Day 0 to 30 (P = 0.027). Significant difference was seen in 3% of SHCT group with the decrease of GI (P = 0.004) from Day 1 to 14. There were no significant difference noted for 0% and 6% SHCT.

    CONCLUSION: The 9% SHCT is the most effective concentration to reduce both the gingival inflammation (up to day 14) and bleeding on probing (up to day 30).

  14. Siddiqui R, Jeyamogan S, Ali SM, Abbas F, Sagathevan KA, Khan NA
    Exp Parasitol, 2017 Dec;183:194-200.
    PMID: 28917711 DOI: 10.1016/j.exppara.2017.09.008
    Crocodiles exist in unsanitary environments, feed on rotten meat, are often exposed to heavy metals such as arsenic, cadmium, cobalt, chromium, mercury, nickel, lead, selenium, tolerate high levels of radiation, and are amid the very few species to survive the catastrophic Cretaceous-Tertiary extinction event, nonetheless they can live for up to a 100 years. Moreover, as they live in unhygienic conditions, they regularly come across pathogens. Logically, we postulate that crocodiles possess mechanisms to defend themselves from noxious agents as well as protecting themselves from pathogens. To test this hypothesis, various organ lysates and serum of Crocodylus palustris were prepared. Amoebicidal assays were performed using Acanthamoeba castellanii belonging to the T4 genotype. Cytotoxicity assays were performed using Prostate cancer cells culture by measuring lactate dehydrogenase release as a marker for cell death. Growth inhibition assays were performed to determine the growth inhibitory effects of various organ lysates. Serum and heart lysates of Crocodylus palustris exhibited powerful anti-tumor activity exhibiting more than 70% Prostate cancer cell death (P 
  15. Chan HK, Soelar SA, Md Ali SM, Ahmad F, Abu Hassan MR
    Asia Pac J Public Health, 2018 03;30(2):137-146.
    PMID: 29292654 DOI: 10.1177/1010539517751312
    The current study examined how the trends in childhood vaccination refusal in Kedah, Malaysia, changed over a 4-year period (2013-2016). Data contributed by 60 public health centers were used to determine the annual incidence rates (per 1000 newborns) of vaccination refusal, and to identify the reasons for refusal among the mothers. The trend analysis revealed a 2.2-times increment in the incidence rates of vaccination refusal from 4.72 in 2013 to 10.51 in 2015, followed by a 52.2% reduction to 5.02 in 2016 ( P = .046). Besides, the proportion of mothers who refused vaccination because of religious belief reduced from 78% between 2013 and 2015 to 67.1% in 2016 ( P = .005). Overall, the finding confirms the positive impact of the educational and religious interventions introduced by the State Health Department of Kedah since January 2016; nonetheless, efforts to strengthen the existing strategies and thereby to maximize the vaccination coverage in Kedah are warranted.
  16. Ali SM, Malik F, Anjum MS, Siddiqui GF, Anwar MN, Lam SS, et al.
    Environ Res, 2021 02;193:110421.
    PMID: 33160973 DOI: 10.1016/j.envres.2020.110421
    A pneumonia-like disease of unknown origin caused a catastrophe in Wuhan city, China. This disease spread to 215 countries affecting a wide range of people. World health organization (WHO) called it a pandemic and it was officially named as Severe Acute Respiratory Syndrome Corona virus 2 (SARS CoV-2), also known as Corona virus disease (COVID-19). This pandemic compelled countries to enforce a socio-economic lockdown to prevent its widespread. This paper focuses on how the particulate matter pollution was reduced during the lockdown period (23 March to April 15, 2020) as compared to before lockdown. Both ground-based and satellite observations were used to identify the improvement in air quality of Pakistan with primary focus on four major cities of Lahore, Islamabad, Karachi and Peshawar. Both datasets have shown a substantial reduction in PM2.5 pollution levels (ranging from 13% to 33% in case of satellite observations, while 23%-58% in ground-based observations) across Pakistan. Result shows a higher rate of COVID-19 spread in major cities of Pakistan with poor air quality conditions. Yet more research is needed in order to establish linkage between COVID-19 spread and air pollution. However, it can be partially attributed to both higher rate of population density and frequent exposure of population to enhanced levels of PM2.5 concentrations before lockdown period.
  17. Hajissa K, Muhajir AEMA, Eshag HA, Alfadel A, Nahied E, Dahab R, et al.
    BMC Res Notes, 2018 Oct 31;11(1):779.
    PMID: 30382901 DOI: 10.1186/s13104-018-3871-y
    OBJECTIVE: Schistosomiasis remains one of the most common parasitic diseases worldwide. This is a cross-sectional study aimed to determine the prevalence of schistosomiasis and its associated risk factors among primary school children in Um-Asher area. The study was conducted among 170 primary school students in Um-Asher area from November 2017 to February 2018. Urine and stool samples were collected and examined for schistosomiasis infections. Moreover, data on sociodemographic characteristics and associated risk factors were obtained using a questionnaire.

    RESULTS: The overall prevalence of Schistosoma haematobium was 12.9%, whereas that of Schistosoma mansoni was 2.95%. Additionally, the males had higher prevalence (60%) of S. mansoni than females (40%). However, both gender were equally infected with S. haematobium (50%). With regard to risk factors, distance of residence from water source and source of drinking water are relatively associated with the infection.

  18. Abu Hassan MR, Hj Md Said R, Zainuddin Z, Omar H, Md Ali SM, Aris SA, et al.
    Heliyon, 2023 Jun;9(6):e16652.
    PMID: 37313177 DOI: 10.1016/j.heliyon.2023.e16652
    BACKGROUND AND PURPOSE: and purpose: Non-alcoholic fatty liver disease (NAFLD) is a significant global health concern with limited pharmacotherapy options. This study aimed to evaluate the effectiveness of a standardized extract of Phyllanthus niruri in mild-to-moderate NAFLD.

    MATERIALS AND METHODS: This was a 12-month randomized controlled trial, in which adults with a controlled attenuation parameter (CAP) score >250 dB/m and a fibrosis score <10 kPa were randomly assigned to receive a standardized P. niruri extract at a dose of 3,000 mg daily (n = 112) or a placebo (n = 114). The primary outcomes were changes in CAP score and liver enzyme levels, while the secondary outcomes were changes in other metabolic parameters. The analysis was performed on an intention-to-treat basis.

    RESULTS: After 12 months, there was no significant difference in the change of CAP score between the intervention and control groups (-15.05 ± 36.76 dB/m vs. -14.74 ± 41.08 dB/m; p = 0.869). There was also no significant difference in the changes of liver enzyme levels between the two groups. However, the intervention group showed a significant reduction in fibrosis score, which was not observed in the control group (-0.64 ± 1.66 kPa versus 0.10 ± 1.61 kPa; p = 0.001). No major adverse events were reported in either group.

    CONCLUSION: This study showed that P. niruri did not significantly reduce CAP score and liver enzyme levels in patients with mild-to-moderate NAFLD. However, a significant improvement in fibrosis score was observed. Further research is needed to determine its clinical benefits at different dosages for NAFLD treatment.

  19. Abd Samat AH, Isa MH, Sabardin DM, Jamal SM, Jaafar MJ, Hamzah FA, et al.
    Ann Acad Med Singap, 2020 Sep;49(9):643-651.
    PMID: 33241252
    INTRODUCTION: This study aims to evaluate the knowledge and confidence of emergency healthcare workers (EHCW) in facing the COVID-19 pandemic.

    MATERIALS AND METHODS: A cross-sectional online study using a validated questionnaire was distributed to doctors (MD), assistant medical officers (AMO), and staff nurses (SN) at an urban tertiary Emergency Department. It comprised of 40 knowledge and 10 confidence-level questions related to resuscitation and airway management steps.

    RESULTS: A total of 135 from 167 eligible EHCW were enrolled. 68.9% (n = 93) had high knowledge while 53.3% (n = 72) possessed high confidence level. Overall knowledge mean score was 32.96/40 (SD = 3.63) between MD (33.88±3.09), AMO (32.28±4.03), and SN (32.00±3.60), P= 0.025. EHCWs with a length of service (LOS) between 4-10 years had the highest knowledge compared to those with LOS <4-year (33.71±3.39 versus 31.21±3.19 P = 0.002). Airway-related knowledge was significantly different between the designations and LOS (P = 0.002 and P = 0.003, respectively). Overall, EHCW confidence level against LOS showed significant difference [F (2, 132) = 5.46, P = 0.005] with longer LOS showing better confidence. MD showed the highest confidence compared to AMO and SN (3.67±0.69, 3.53±0.68, 3.26±0.64) P = 0.049. The majority EHCW were confident in performing high-quality chest-compression, and handling of Personal Protective Equipment but less than half were confident in resuscitating, leading the resuscitation, managing the airway or being successful in first intubation attempt.

    CONCLUSIONS: EHCW possessed good knowledge in airway and resuscitation of COVID-19 patients, but differed between designations and LOS. A longer LOS was associated with better confidence, but there were some aspects in airway management and resuscitation that needed improvement.

  20. Karbwang J, Koonrungsesomboon N, Torres CE, Jimenez EB, Kaur G, Mathur R, et al.
    BMC Med Ethics, 2018 09 15;19(1):79.
    PMID: 30219106 DOI: 10.1186/s12910-018-0318-x
    BACKGROUND: The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research.

    METHODS: This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important).

    RESULTS: Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be 'moderately important' to 'very important' for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively).

    CONCLUSIONS: Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

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