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Fulltext Giant Parathyroid Adenoma versus Parathyroid Carcinoma: Differentiating Two Entities

Aziz H, Hussein Z

J ASEAN Fed Endocr Soc, 2021;36(1):104-107.
PMID: 34177097 DOI: 10.15605/jafes.036.01.11

Giant parathyroid adenoma (GPA) is defined as adenoma larger than 3.5 g. Twenty-one cases of parathyroid mass >3.5 g in patients with primary hyperparathyroidism who underwent parathyroidectomy in Hospital Putrajaya, Malaysia were identified. Most cases presented with nephrolithiasis. Two cases are reported as parathyroid cancer. GPA has significantly higher serum calcium and iPTH levels and can be asymptomatic. Parathyroid carcinoma patients are frequently symptomatic, with large tumors. Differentiating GPA from parathyroid cancer is important as it determines the subsequent surgical intervention.
Evaluation of thermochemical pretreatment and continuous thermophilic condition in rice straw composting process enhancement

Hosseini SM, Abdul Aziz H

Bioresour Technol, 2013 Apr;133:240-7.
PMID: 23428821 DOI: 10.1016/j.biortech.2013.01.098

The effects of thermochemical pretreatment and continuous thermophilic conditions on the composting of a mixture of rice straw residue and cattle manure were investigated using a laboratory-scale composting reactor. Results indicate that the composting period of rice straw can be shortened to less than 10 days by applying alkali pre-treatment and continuous thermophilic composting conditions. The parameters obtained on day 9 of this study are similar to the criteria level published by the Canadian Council of Ministers of the Environment. The moisture content, organic matter reduction, pH level, electrical conductivity, total organic carbon reduction, soluble chemical oxygen demand reduction, total Kjeldahl nitrogen, carbon-to-nitrogen ratio, and germination index were 62.07%, 16.99%, 7.30%, 1058 μS/cm, 17.00%, 83.43%, 2.06%, 16.75%, and 90.33%, respectively. The results of this study suggest that the application of chemical-biological integrated processes under thermophilic conditions is a novel method for the rapid degradation and maturation of rice straw residue.
Hypercalcaemia associated with disseminated cryptococcosis

Aziz H, Adam NL, Karim NA

BMJ Case Rep, 2021 Dec 08;14(12).
PMID: 34880036 DOI: 10.1136/bcr-2021-245025

We report an elderly man who presented with giddiness and right-sided weakness, constipation and constitutional symptoms for 6 months duration. Blood investigations indicated hypercalcaemia with normal serum phosphate and acute kidney injury. Serum intact parathyroid hormone was suppressed. CT revealed bilateral tiny lung nodules with right upper lobe tree in bud appearance and incidental findings of bilateral adrenal lesion. Tuberculosis was ruled out. CT adrenal showed multiseptated hypodense rim enhancement adrenal lesion bilaterally. Adrenal function tests were normal except for low dehydroepiandrosterone (DHEA). Right-sided cervical lymph node biopsy confirmed fungal infection with the presence of intracellular and extracellular fungal yeast. Serum cryptococcus antigen titre was positive. Our final diagnosis was disseminated cryptococcosis with lungs, bilateral adrenal gland and lymph nodes involvement. The patient was then treated with antifungal treatment. Serum calcium was normalised after 1 month with marked clinical improvement.
Comparison performance of coagulation flocculation process and combination with ozonation process of stabilized landfill leachate treatment

Zakaria SNF, Abdul Aziz H, Mohamad M

Water Environ Res, 2022 Jul 15;94(8):e10770.
PMID: 35915388 DOI: 10.1002/wer.10770

Landfill leachate is well known as a hazardous byproduct from dumpling sites that has a negative impact on the environment and human life. Therefore, an effective treatment is imperative to overcome this issue. This research study investigates the effectiveness of zirconium tetrachloride (ZrCl4 ) and tin tetrachloride (SnCl4 ) as a coagulant in leachate treatment. Two parameters selected as a performance indicator in this study are color and chemical oxygen demand (COD). The data obtained showed that SnCl4 performed well as a coagulant with removal percentages of color and COD, which are 97% and 77%, respectively. Furthermore, the potential of integrated treatment using ozonation (O3 ) and the coagulation-flocculation process was also investigated. Four sequences of integrated treatment setup for this study were ozonation followed by jar test (ZrCl4 as a coagulant), ozonation followed by jar test (SnCl4 as a coagulant), jar test (ZrCl4 as a coagulant) followed by the ozonation process, and jar test (SnCl4 as a coagulant) followed by the ozonation process. The experimental data showed that the combination treatment of SnCl4 as a coagulant (jar test) followed by the ozonation process had recorded the highest removal of color (97.1%) and COD (88%) compared to other sequences. Moreover, the biodegradability ratio of this sequence also improved from 0.03 to 0.28, compared with other methods. Comparatively, integrated treatment is more effective in treating stabilized landfill leachate compared to the coagulation flocculation process alone. PRACTITIONER POINTS: Stabilized landfill leachate is difficult to be treated by natural coagulants or biological process. SnCl4 performed well as a coagulant in removing COD and colour from landfill leachate compared to ZrCl4 . However, too much usage of SnCl4 potentially generate secondary pollutant. Therefore, combination with O3 as pre-treatment is investigated. Combination treatment of SnCl4 ( as coagulant) with O3 had recorded the highest removal of colour (97.1%) and COD (88%). The biodegradability ratio of this sequence also improved from 0.03 to 0.28.
Fulltext How payment scheme affects patients' adherence to medications? A systematic review

Aziz H, Hatah E, Makmor Bakry M, Islahudin F

Patient Prefer Adherence, 2016;10:837-50.
PMID: 27313448 DOI: 10.2147/PPA.S103057

BACKGROUND: A previous systematic review reported that increase in patients' medication cost-sharing reduced patients' adherence to medication. However, a study among patients with medication subsidies who received medication at no cost found that medication nonadherence was also high. To our knowledge, no study has evaluated the influence of different medication payment schemes on patients' medication adherence.
OBJECTIVE: This study aims to review research reporting the influence of payment schemes and their association with patients' medication adherence behavior.
METHODS: This study was conducted using systematic review of published articles. Relevant published articles were located through three electronic databases Medline, ProQuest Medical Library, and ScienceDirect since inception to February 2015. Included articles were then reviewed and summarized narratively.
RESULTS: Of the total of 2,683 articles located, 21 were included in the final analysis. There were four types of medication payment schemes reported in the included studies: 1) out-of-pocket expenditure or copayments; 2) drug coverage or insurance benefit; 3) prescription cap; and 4) medication subsidies. Our review found that patients with "lower self-paying constraint" were more likely to adhere to their medication (adherence rate ranged between 28.5% and 94.3%). Surprisingly, the adherence rate among patients who received medication as fully subsidized was similar (rate between 34% and 84.6%) as that of other payment schemes. The studies that evaluated patients with fully subsidized payment scheme found that the medication adherence was poor among patients with nonsevere illness.
CONCLUSION: Although medication adherence was improved with the reduction of cost-sharing such as lower copayment, higher drug coverage, and prescription cap, patients with full-medication subsidies payment scheme (received medication at no cost) were also found to have poor adherence to their medication. Future studies comparing factors that may influence patients' adherence to medication among patients who received medication subsidies should be done to develop strategies to overcome medication nonadherence.
KEYWORDS: drug cost; medication adherence; medication payment scheme
Fulltext A comparison of medication adherence between subsidized and self-paying patients in Malaysia

Aziz H, Hatah E, Makmor-Bakry M, Islahudin F, Ahmad Hamdi N, Mok Pok Wan I

Malays Fam Physician, 2018;13(2):2-9.
PMID: 30302177 MyJurnal

Background: Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients.
Objective: To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients' adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia.
Methods: This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient's medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients' adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence.
Results: A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ2=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients' medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p = 0.006).
Conclusion: There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.
Synthesis of natural starch from Elaeis guineensis trunk biomass applying bisulphite steeping method: Optimization by RSM

Ahmed Z, Yusoff MS, N H MK, Abdul Aziz H

J Air Waste Manag Assoc, 2022 01;72(1):116-130.
PMID: 33872123 DOI: 10.1080/10962247.2021.1919240

A massive quantity of Elaeis guineensis (oil palm) trunk biomass, containing a significant amount of natural starch, is available in Malaysia as biowaste because of annual replantation. The efficient extraction of this starch (carbohydrate polymer) would be worthwhile concerning the environmental sustainability and economy through conversion to bioresources. This study investigated the effectiveness of the bisulfite steeping method for starch synthesis from oil palm trunk (OPT) biowaste. The central composite design (CCD) of Design-Expert software executed an experimental model design, data analysis, evaluated the impacts of process variables and their interaction through response surface methodology to optimize the bisulfite steeping method for starch synthesis. The developed quadratic models for four factors (strength of sodium bisulfite solution, steeping hour, mixing ratio with the bisulfite solution, and ultrapure water) and one response (%Yield) demonstrated that a significant starch yield (13.54%) is achievable employing 0.74% bisulfite solution, 5.6 steeping hours, for 1.6 and 0.6 mixing ratio with the bisulfite solution and ultrapure water respectively. Experimental outcomes were consistent with the predicted model, which eventually sustains the significance of this method. Malvern Zetasizer test revealed a bimodal granular distribution for starch, with 7.15 µm of hydrodynamic size. Starch morphology was determined by scanning electron microscopy. X-ray diffraction investigation exhibits an A-type model, specifying persistent characteristics, while FTIR confirms the presence of hydroxyl, carboxylic, and phenolic groups like other cereal starches.Implications: Malaysia is the 2nd largest palm oil exporter in the world. About 110 million tons of palm oil trunk (OPT) biomass is available annually during replanting activities. Modification of bio-wastes into a beneficial form (only 22% presently) like starch extraction would ensure potential reuse as a natural coagulant for wastewater and leachate treatment, food source, adhesives towards boosting the country's economy by sustainable waste management. The current study achieved better starch yield (13.54%) than previous, from the OPT biomass through the novel bisulfite steeping method. Therefore, this method will ascertain the effective implication of numerous economic activities.
Response surface analysis and modeling of n-alkanes removal through bioremediation of weathered crude oil

Mohajeri L, Abdul Aziz H, Ali Zahed M, Mohajeri S, Mohamed Kutty SR, Hasnain Isa M

Water Sci Technol, 2011;63(4):618-26.
PMID: 21330705 DOI: 10.2166/wst.2011.211

Central composite design (CCD) and response surface methodology (RSM) were employed to optimize four important variables, i.e. amounts of oil, bacterial inoculum, nitrogen and phosphorus, for the removal of selected n-alkanes during bioremediation of weathered crude oil in coastal sediments using laboratory bioreactors over a 60 day experimentation period. The reactors contained 1 kg soil with different oil, microorganisms and nutrients concentrations. The F Value of 26.89 and the probability value (P < 0.0001) demonstrated significance of the regression model. For crude oil concentration of 2, 16 and 30 g per kg sediments and under optimized conditions, n-alkanes removal was 97.38, 93.14 and 90.21% respectively. Natural attenuation removed 30.07, 25.92 and 23.09% n-alkanes from 2, 16 and 30 g oil/kg sediments respectively. Excessive nutrients addition was found to inhibit bioremediation.
Sustainable wastewater treatment by biochar/layered double hydroxide composites: Progress, challenges, and outlook

Zubair M, Ihsanullah I, Abdul Aziz H, Azmier Ahmad M, Al-Harthi MA

Bioresour Technol, 2021 Jan;319:124128.
PMID: 32979597 DOI: 10.1016/j.biortech.2020.124128

Biochar/layered double hydroxide (LDH) composites have gained considerable attention in recent times as low-cost sustainable materials for applications in water treatment. This paper critically evaluates the latest development in applications of biochar/LDH composites in water treatment with an emphasis on adsorption and catalytic degradation of various pollutants. The adsorption of various noxious contaminants, i.e., heavy metals, dyes, anions, and pharmaceuticals onto biochar/LDH composites are described in detail by elaborating the adsorption mechanism and regeneration ability. The synergistic effect of LDH with biochar exhibited significant improvement in specific surface area, surface functional groups, structure heterogeneity, stability, and adsorption characteristics of the resulting biochar/LDH composites. The major hurdles and challenges associated with the synthesis and applications of biochar/LDH composites in water remediation are emphasized. Finally, a roadmap is suggested for future research to assure the effective applications of biochar/LDH composites in water purification.
Fulltext Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia

Aziz H, Hatah E, Makmor-Bakry M, Islahudin F, Ahmad Hamdi N, Mok Pok Wan I

BMC Health Serv Res, 2018 08 06;18(1):605.
PMID: 30081892 DOI: 10.1186/s12913-018-3417-y

BACKGROUND: Numerous studies have evaluated the related factors of medication adherence among patients with chronic disease. However, the factors influencing medication adherence and non-adherence among subsidised patients with chronic diseases-for whom medication costs may not be a constraint-remain unexplored. Thus, this study aims to identify and compare the potential factors that may influence subsidised and non-subsidised (i.e., self-paying) patients' adherence to medication.
METHODS: Subsidised and self-paying patients were identified at public and private healthcare institutions in three states of Malaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication adherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring System (MEMS). Adherence was defined as having 80% or more for the percentage of days in which the dose regimen was executed as prescribed. The interview was conducted from January to August 2016 and during the interviews, patients were asked to provide reasons for their medication adherence or non-adherence. The patient interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis with NVivo 11 software.
RESULTS: Thirteen subsidised and 12 self-paying patients were interviewed. The themes found among subsidised and self-paying patients were similar. The factors that influenced adherence to medication include the 'perceived importance of quality of life' and 'perceived benefit or value of the medications'. A unique factor reported by patients in this study included 'perceived value of the money spent on medications'; more specifically, patients adhered to their medications because they valued the money spent to buy/receive the medications.
CONCLUSION: Medication adherence among subsidised and self-paying patients was influenced by many factors, including a unique factor relating to their perceptions of the value of money spent on medications.
Fulltext Bilateral Serous Retinal Detachment in Pregnancy

Phang DSK, Ariffin N, Abd Aziz H, Vendargon FM, Sonny Teo KS

Cureus, 2022 Oct;14(10):e30019.
PMID: 36348857 DOI: 10.7759/cureus.30019

Serous retinal detachment is a rare complication of pregnancy. A 30-year-old primigravida with preeclampsia presented with bilateral blurring of vision and metamorphopsia for a one-week duration. She was referred by the Obstetrics and Gynecology department for visual assessment. Her best corrected visual acuity was 6/7.5 in both eyes. Fundus examination revealed bilateral serous retinal detachment involving maculae. She was treated conservatively and her blood pressure normalized after delivery. There was a partial resolution of subretinal fluid one-month post-delivery and a complete resolution of subretinal fluid three months later. Her final best corrected visual acuity was 6/6 and N5 in both eyes. The management of serous retinal detachment is conservative with a good visual outcome.
Gene Mutations as Emerging Biomarkers and Therapeutic Targets for Relapsed Acute Myeloid Leukemia

Aziz H, Ping CY, Alias H, Ab Mutalib NS, Jamal R

Front Pharmacol, 2017;8:897.
PMID: 29270125 DOI: 10.3389/fphar.2017.00897

It is believed that there are key differences in the genomic profile between adult and childhood acute myeloid leukemia (AML). Relapse is the significant contributor of mortality in patients with AML and remains as the leading cause of cancer death among children, posing great challenges in the treatment of AML. The knowledge about the genomic lesions in childhood AML is still premature as most genomic events defined in children were derived from adult cohorts. However, the emerging technologies of next generation sequencing have narrowed the gap of knowledge in the biology of AML by the detection of gene mutations for each sub-type which have led to the improvement in terms of prognostication as well as the use of targeted therapies. In this review, we describe the recent understanding of the genomic landscape including the prevalence of mutation, prognostic impact, and targeted therapies that will provide an insight into the pathogenesis of AML relapse in both adult and childhood cases.
Fulltext A Rare Complication of Herpes Zoster Ophthalmicus (HZO)

Phang DSK, Ettikan JV, Abd Aziz H, Vendargon FM, Sonny Teo KS

Cureus, 2023 Mar;15(3):e35693.
PMID: 37012964 DOI: 10.7759/cureus.35693

Retrobulbar optic neuritis is a rare complication of herpes zoster ophthalmicus (HZO). We report a case of a 27-year-old man who presented with a progressive left blurring of vision for one week. A history of vesicular rashes in the left trigeminal nerve area preceded his condition. On examination, we noted that his left eye visual acuity was hand movement, and his optic nerve function was reduced. Findings from examining the anterior segment and intraocular pressure were unremarkable. The fundus examination results were normal. A blood investigation was positive for human immunodeficiency virus (HIV). MRI showed hyperintense features of the intraorbital segment of the optic nerve in the T2-weighted image. An abnormal high signal on a T2 weighted image may be present, which may be a clue for varicella zoster associated complications, such as HZO-related optic neuritis. Therefore, a diagnosis of retrobulbar optic neuritis was made, and antiviral treatment was initiated. He received two weeks of IV acyclovir and switched to the oral route for one month. After the completion of the treatment, his visual acuity remained the same.
Pharmaceutical residues in the ecosystem: Antibiotic resistance, health impacts, and removal techniques

Husain Khan A, Abdul Aziz H, Palaniandy P, Naushad M, Cevik E, Zahmatkesh S

Chemosphere, 2023 Oct;339:139647.
PMID: 37516325 DOI: 10.1016/j.chemosphere.2023.139647

Hospital wastewater has emerged as a major category of environmental pollutants over the past two decades, but its prevalence in freshwater is less well documented than other types of contaminants. Due to compound complexity and improper operations, conventional treatment is unable to remove pharmaceuticals from hospital wastewater. Advanced treatment technologies may eliminate pharmaceuticals, but there are still concerns about cost and energy use. There should be a legal and regulatory framework in place to control the flow of hospital wastewater. Here, we review the latest scientific knowledge regarding effective pharmaceutical cleanup strategies and treatment procedures to achieve that goal. Successful treatment techniques are also highlighted, such as pre-treatment or on-site facilities that control hospital wastewater where it is used in hospitals. Due to the prioritization, the regulatory agencies will be able to assess and monitor the concentration of pharmaceutical residues in groundwater, surface water, and drinking water. Based on the data obtained, the conventional WWTPs remove 10-60% of pharmaceutical residues. However, most PhACs are eliminated during the secondary or advanced therapy stages, and an overall elimination rate higher than 90% can be achieved. This review also highlights and compares the suitability of currently used treatment technologies and identifies the merits and demerits of each technology to upgrade the system to tackle future challenges. For this reason, pharmaceutical compound rankings in regulatory agencies should be the subject of prospective studies.
Removal of copper from water using limestone filtration technique. Determination of mechanism of removal

Aziz HA, Othman N, Yusuff MS, Basri DR, Ashaari FA, Adlan MN, et al.

Environ Int, 2001 May;26(5-6):395-9.
PMID: 11392757

This paper discusses heavy metal removal from wastewater by batch study and filtration technique through low-cost coarse media. Batch study has indicated that more than 90% copper (Cu) with concentration up to 50 mg/l could be removed from the solution with limestone quantity above 20 ml (equivalent to 56 g), which indicates the importance of limestone media in the removal process. This indicates that the removal of Cu is influenced by the media and not solely by the pH. Batch experiments using limestone and activated carbon indicate that both limestone and activated carbon had similar metal-removal efficiency (about 95%). Results of the laboratory-scale filtration technique using limestone particles indicated that above 90% removal of Cu was achieved at retention time of 2.31 h, surface-loading rate of 4.07 m3/m2 per day and Cu loading of 0.02 kg/m3 per day. Analyses of the limestone media after filtration indicated that adsorption and absorption processes were among the mechanisms involved in the removal processes. This study indicated that limestone can be used as an alternative to replace activated carbon.
Fulltext Deep Transcriptome Sequencing of Pediatric Acute Myeloid Leukemia Patients at Diagnosis, Remission and Relapse: Experience in 3 Malaysian Children in a Single Center Study

Osman SH, Abu N, Aziz H, Chow YP, Wan Mohamad Nazarie WF, Ab Mutalib NS, et al.

Front Genet, 2020;11:66.
PMID: 32174960 DOI: 10.3389/fgene.2020.00066
Decellularization and genipin crosslinking of amniotic membrane suitable for tissue engineering applications

Gobinathan S, Zainol SS, Azizi SF, Iman NM, Muniandy R, Hasmad HN, et al.

J Biomater Sci Polym Ed, 2018 12;29(17):2051-2067.
PMID: 29983100 DOI: 10.1080/09205063.2018.1485814

Amniotic membrane has the potential to be used as scaffold in various tissue engineering applications. However, increasing its biostability at the same time maintaining its biocompatibility is important to enhance its usage as a scaffold. This studied characteristics genipin-crosslinked amniotic membrane as a bioscaffold. Redundant human amniotic membranes (HAM) divided into native (nAM), decellularized (dAM) and genipin-crosslinked (clAM) groups. The dAM and clAM group were decellularized using thermolysin (TL) and sodium hydroxide (NaOH) solution. Next, clAM group was crosslinked with 0.5% and 1.0% (w/v) genipin. The HAM was then studied for in vitro degradation, percentage of swelling, optical clarity, ultrastructure and mechanical strength. Meanwhile, fibroblasts isolated from nasal turbinates were then seeded onto nAM, dAM and clAM for biocompatibility studies. clAM had the slowest degradation rate and were still morphologically intact after 30 days of incubation in 0.01% collagenase type 1 solution. The dAM had a significantly highest percentage of swelling than other groups (p
Fulltext Determination and risk assessment of pharmaceutical residues in the urban water cycle in Selangor Darul Ehsan, Malaysia

Mohd Hanafiah Z, Wan Mohtar WHM, Abd Manan TS, Bachi NA, Abu Tahrim N, Abd Hamid HH, et al.

PeerJ, 2023;11:e14719.
PMID: 36748091 DOI: 10.7717/peerj.14719

The environmental fate of non-steroidal anti-inflammatory drugs (NSAIDs) in the urban water cycle is still uncertain and their status is mainly assessed based on specific water components and information on human risk assessments. This study (a) explores the environmental fate of NSAIDs (ibuprofen, IBU; naproxen, NAP; ketoprofen, KET; diazepam, DIA; and diclofenac, DIC) in the urban water cycle, including wastewater, river, and treated water via gas chromatography-mass spectrophotometry (GCMS), (b) assesses the efficiency of reducing the targeted NSAIDs in sewage treatment plant (STP) using analysis of variance (ANOVA), and (c) evaluates the ecological risk assessment of these drugs in the urban water cycle via teratogenic index (TI) and risk quotient (RQ). The primary receptor of contaminants comes from urban areas, as a high concentration of NSAIDs is detected (ranging from 5.87 × 103 to 7.18 × 104 ng/L). The percentage of NSAIDs removal in STP ranged from 25.6% to 92.3%. The NAP and KET were still detected at trace levels in treated water, indicating the persistent presence in the water cycle. The TI values for NAP and DIA (influent and effluent) were more than 1, showing a risk of a teratogenic effect. The IBU, KET, and DIC had values of less than 1, indicating the risk of lethal embryo effects. The NAP and DIA can be classified as Human Pregnancy Category C (2.1 > TI ≥ 0.76). This work proved that these drugs exist in the current urban water cycle, which could induce adverse effects on humans and the environment (RQ in high and low-risk categories). Therefore, they should be minimized, if not eliminated, from the primary sources of the pollutant (i.e., STPs). These pollutants should be considered a priority to be monitored, given focus to, and listed in the guideline due to their persistent presence in the urban water cycle.
Fulltext Cost analysis of periodontitis management in public sector specialist dental clinics

Mohd-Dom T, Ayob R, Mohd-Nur A, Abdul-Manaf MR, Ishak N, Abdul-Muttalib K, et al.

BMC Oral Health, 2014 May 20;14:56.
PMID: 24884465 DOI: 10.1186/1472-6831-14-56

BACKGROUND: The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components.
METHODS: Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4).
RESULTS: A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P
Fulltext Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer

Elghazaly H, Rugo HS, Azim HA, Swain SM, Arun B, Aapro M, et al.

Cancers (Basel), 2021 May 08;13(9).
PMID: 34066769 DOI: 10.3390/cancers13092262

Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.

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