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Fulltext Stem cell therapy as a potential treatment for glaucoma

Kamal, M., Amini, F., Ramasamy, TS

JUMMEC, 2016;19(1):23-32.
MyJurnal

Glaucoma is a common eye disease that can cause irreversible damage if left undiagnosed and untreated. It is one of the most common neurodegenerative diseases causing blindness. Pre-clinical studies have been carried out on animal models of glaucoma for stem cell therapy. We carried out a systematic review to determine whether stem cell therapy had the potential to treat glaucoma. Nine studies were selected based on the predetermined inclusion and exclusion criteria. Of these nine studies, eight focused on neuroprotection conferred by stem cells, and the remaining one on neuroregeneration. Results from these studies showed that there was a potential in stem cell based therapy in treating glaucoma, especially regarding neuroprotection via neurotrophic factors. The studies revealed that a brain-derived neurotrophic factor expressed by stem cells promoted the survival of retinal ganglion cells in murine glaucoma models. The transplanted cells survived without any side effects. While these studies proved that stem cells provided neuroprotection in glaucoma, improvement of vision could not be determined. Clinical studies would be required to determine whether the protection of RGC correlated with improvement in visual function. Furthermore, these murine studies could not be translated into clinical therapy due to the heterogeneity of the experimental methods and the
use of different cell lines. In conclusion, the use of stem cells in the clinical therapy of glaucoma will be an important step in the future as it will transform present-day treatment with the hope of restoring sight to patients with glaucoma.
Fulltext Drying effect on the properties of traditionally processed sago starch

Mustafa Kamal, M., Baini, R., Lim, S. F., Rahman, M. R., Mohamaddan, S., Hussain, H.

International Food Research Journal, 2019;26(6):1861-1869.
MyJurnal

Local people in Sarawak, Malaysia produce sago starch, commonly referred as lemantak, using traditional method for authentic meals and delicacies. The quality of lemantak degrades with time due to its high moisture content limiting the potential for a wider market, and hence affecting the socio-economy of those whose livelihood depends on sago starch production. The objective of the present work was to evaluate the changes in the properties of traditionally processed dried Sarawak sago starch. In order to achieve this, sago starch was extracted using a well-established traditional process and was dried at 40°C to produce sago starch with moisture contents of 40%, 30%, 20% and 10% wet basis. The effect of moisture content on the physical properties was studied through colour analysis, microscopic analysis, and particle size distribution. Analysis on resistant starch content was also performed. Changes on the hydration and functional properties was monitored by measuring the water absorption index (WAI), water solubility index (WSI), swelling capacity (SC), and gelatinisation behaviour. Lastly, Fourier transform-infrared spectroscopy (FT-IR) was applied to observe the changes in amorphous and crystalline areas. The physical properties analysis showed changes in starch colour and granule surface; but the change on granule size varied. Dried starch with lower moisture content exhibited higher resistant starch, absorption index, and peak temperature, but lower solubility index, swelling capacity, peak viscosity, crystalline index, and amorphous index. It is suggested that moisture content affected the changes in traditionally processed sago starch properties which was influenced by few components namely polyphenol, lipid, amylose-lipid complex, and inter-molecular hydrogen bond.
A comparison between infrared tympanic thermometry, oral and axilla with rectal thermometry in neutropenic adults

Dzarr AA, Kamal M, Baba AA

Eur J Oncol Nurs, 2009 Sep;13(4):250-4.
PMID: 19386547 DOI: 10.1016/j.ejon.2009.03.006

This study assessed the agreement between infrared tympanic membrane (TM), axillary, corrected axillary (+0.5 degrees C), oral, and corrected oral (+0.3 degrees C) to rectal thermometry as reference standard in neutropenic adults. The sensitivity and specificity of the mentioned thermometries in detecting rectal fever (> or =38 degrees C) were also analysed.
Fulltext Proximal third femoral shaft fractures in children: prevention of angular deformities using bilateral Thomas splints

Kamal MH, Razak M, Ibrahim S, Lim A

Med J Malaysia, 2000 Sep;55 Suppl C:68-73.
PMID: 11200047

This is a prospective study to look at the outcome of unilateral proximal third femoral shaft fractures in children treated with a bilateral Thomas splint in the Department of Orthopaedic Surgery Universiti Kebangsaan Malaysia between the period of January 1996 and June 1998. Eighteen children aged between 2 years and 12 years old with unilateral proximal third fractures of the femoral shaft were treated using a bilateral Thomas splint. Angular deformities were measured using a goniometer metric scale before and after Thomas splints. The percentage of varus tilt corrected ranged from 17% to 72% with an average correction of 29% from the initial deformity and the difference was statistically significant (p < 0.05). The percentage of posterior tilt corrected ranged from 19% to 60% with the average correction of 20% from the initial deformity. The difference was statistically significant (p < 0.05). From this study, we conclude that bilateral Thomas splints can give a better correction of angular deformity for proximal third femoral shaft fractures in children below twelve years of age.
Tuberculoid granulomatous lesion of the pharynx--review of the literature

Sharma HS, Kurl DN, Kamal MZ

Auris Nasus Larynx, 1998 May;25(2):187-91.
PMID: 9673733

Pharyngeal involvement in tuberculosis is rare and is usually secondary to pulmonary tuberculosis. We report a very rare case of chronic granulomatous pharyngitis, which later turned out to be due to primary tuberculosis of the pharynx. The clinical presentation, diagnosis, treatment and complications of this rare clinical entity are presented.
Fulltext The value of aqueous assessment in diagnosing dry eye. [Abstract]

Ithnin MH, Ariffin AE, Mohd Kamal M

International Medical Journal Malaysia, 2017;16(11):14.
MyJurnal

Introduction: The clinical evaluation of the three layers of tear film is still poorly described. The purpose of this study is to evaluate the value of aqueous assessment in diagnosing dry eye.
Materials and method: Schirmer test with anaesthesia (STA) and tear meniscus height (TMH) measurement were conducted on non-dry eye (NDE) and dry eye (DE) subjects in this cross-sectional study. The NDE and DE subjects were classified using two types of classification; classification 1 and classification 2.
Results: 321 subjects with 642 eyes were recruited in the study. STA was significantly correlated with TMH (r = 0.24, p < 0.001) in all 642 eyes. The comparison between nondry and dry eye subjects in STA and TMH were not significantly different (p > 0.05) if the Classification 1 was used to define dry eye. In Classification 2, there were significantly different between NDE (12.5 ± 8.2 mm) and DE (3.4 ± 0.8 mm) subjects in STA (p < 0.001). Similar trend was also depicted in TMH based on the definition of dry eye stated in Classification 2 (NDE = 0.45 ± 0.20 mm, DE = 0.39 ± 0.14 mm; p < 0.05).
Conclusion: The value of STA and TMH were lower significantly in dry eye subjects. However, the significant outcomes were only demonstrated if the clinical signs of dryness were used in the definition of dry eye.
Fulltext A discrete event simulation model for evaluating the performances of an m/g/c/c state dependent queuing system

Khalid R, Nawawi MK, Kawsar LA, Ghani NA, Kamil AA, Mustafa A

PLoS One, 2013;8(4):e58402.
PMID: 23560037 DOI: 10.1371/journal.pone.0058402

M/G/C/C state dependent queuing networks consider service rates as a function of the number of residing entities (e.g., pedestrians, vehicles, and products). However, modeling such dynamic rates is not supported in modern Discrete Simulation System (DES) software. We designed an approach to cater this limitation and used it to construct the M/G/C/C state-dependent queuing model in Arena software. Using the model, we have evaluated and analyzed the impacts of various arrival rates to the throughput, the blocking probability, the expected service time and the expected number of entities in a complex network topology. Results indicated that there is a range of arrival rates for each network where the simulation results fluctuate drastically across replications and this causes the simulation results and analytical results exhibit discrepancies. Detail results that show how tally the simulation results and the analytical results in both abstract and graphical forms and some scientific justifications for these have been documented and discussed.
Relative salinity tolerance of warm season turfgrass species

Uddin KM, Juraimi AS, Ismail MR, Othman R, Rahim AA

J Environ Biol, 2011 May;32(3):309-12.
PMID: 22167942

Fresh water, coupled with soil salinization in many areas has resulted in an increased need forscreening of salt tolerant turf grasses. Relative salinity tolerance of eightwarm season turfgrass species were examined in this study in sand culture. Grasses were grown in a glasshouse, irrigated with either distilled water or saline sea water adjusted to 24, 48 or 72 dSm-1. Salt tolerances of the grasses were assessed on the basis of their shoot and root growth, leaf firing and turf quality. Regression analysis indicated that Zoysiajaponica (Japanese lawn grass) (JG), Stenotaphrum secundatum (St. Augustine) (SA), Cynodon dactylon (satiri) (BS), Zoysia teneuifolia (Korean grass) (KG), Digitaria didactyla (Serangoon grass) (SG), Cynodon dactylon (Tifdwarf) (TD), Paspalum notatum (Bahia grass) (BG) and Axonopus compressus(Pearl blue) (PB) suffered a 50% shoot growth reduction at 36.0, 31.8, 30.9, 28.4, 26.4, 25.7, 20.0 and 18.6 dSm1 of salinity, respectively and a root growth reduction at44.9, 43.7, 33.4, 31.0, 29.5 27.5, 21.5 and 21.4 dSm- of salinity, respectively. Leaf firing and turf quality of the selected species, as a whole, were also found to be affected harmoniously with the change in root and shoot growth. On the basis of the experimental results the selected species were ranked for salinity tolerance as JG>SA>BS>KG>SG >TD>BG>PB.
Metastatic osteosarcoma of the ethmoid: an unusual cause of recurrent epistaxis and proptosis

Sharma HS, Reddy SC, Mohamad A, Kamal MZ, Halder D

J Laryngol Otol, 1996 Jul;110(7):676-8.
PMID: 8759546

Osteosarcoma is the most common primary malignant tumour of bone and it usually metastasises to the lung. In the nasal cavity metastatic disease is extremely rare. We describe a case of osteosarcoma presenting with recurrent epistaxis, and proptosis due to secondaries in the nasal cavity. To our knowledge such a case has not been reported previously in the available English literature.
Fulltext Requirements, Deployments, and Challenges of LoRa Technology: A Survey

Ayoub Kamal M, Alam MM, Sajak AAB, Mohd Su'ud M

Comput Intell Neurosci, 2023;2023:5183062.
PMID: 36654727 DOI: 10.1155/2023/5183062

LoRa is an ISM-band based LPWAN communication protocol. Despite their wide network penetration of approximately 20 kilometers or higher using lower than 14 decibels transmitting power, it has been extensively documented and used in academia and industry. Although LoRa connectivity defines a public platform and enables users to create independent low-power wireless connections while relying on external architecture, it has gained considerable interest from scholars and the market. The two fundamental components of this platform are LoRaWAN and LoRa PHY. The consumer LoRaWAN component of the technology describes the network model, connectivity procedures, ability to operate the frequency range, and the types of interlinked gadgets. In contrast, the LoRa PHY component is patentable and provides information on the modulation strategy which is being utilized and its attributes. There are now several LoRa platforms available. To create usable LoRa systems, there are presently several technical difficulties to be overcome, such as connection management, allocation of resources, consistent communications, and security. This study presents a thorough overview of LoRa networking, covering the technological difficulties in setting up LoRa infrastructures and current solutions. Several outstanding challenges of LoRa communication are presented depending on our thorough research of the available solutions. The research report aims to stimulate additional research toward enhancing the LoRa Network capacity and allowing more realistic installations.
Prawn biomonitors of nutrient and trace metal pollution along Asia-Pacific coastlines

Fry B, Carter JF, Tinggi U, Arman A, Kamal M, Metian M, et al.

Isotopes Environ Health Stud, 2016 Dec;52(6):619-32.
PMID: 26982881 DOI: 10.1080/10256016.2016.1149481

To assess coastal ecosystem status and pollution baselines, prawns were collected from the commercial catches of eight Asia-Pacific countries (Australia, Bangladesh, Indonesia, Myanmar, Philippines, Pakistan, Sri Lanka and Thailand). Samples collected from 21 sites along regional coastlines were analysed for trace metal and stable isotopic compositions of H, C, N, O and S. A combination of simple averaging and multivariate analyses was used to evaluate the data. Sites could be assigned to easily recognise polluted and unpolluted groups based on the prawn results. Some filter-feeding clams were also collected and analysed together with the benthic-feeding prawns, and the prawns generally had lower trace metal burdens. Climate change effects were not strongly evident at this time, but altered ocean circulation and watershed run-off patterns accompanying future climate change are expected to change chemical patterns recorded by prawns along these and other coastlines. Stable isotopes, especially (15)N, can help to distinguish between relatively polluted and unpolluted sites.
Fourth branchial pouch cyst: an unusual cause of neonatal stridor

Sharma HS, Razif A, Hamzah M, Dharap AS, Mahbar Z, Kamal MZ, et al.

Int J Pediatr Otorhinolaryngol, 1996 Dec 20;38(2):155-61.
PMID: 9119603

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.
Proteomics of Sago Palm Towards Identifying Contributory Proteins in Stress-Tolerant Cultivar

Hussain H, Mustafa Kamal M, Al-Obaidi JR, Hamdin NE, Ngaini Z, Mohd-Yusuf Y

Protein J, 2020 02;39(1):62-72.
PMID: 31863255 DOI: 10.1007/s10930-019-09878-9

Metroxylon sagu Rottb. or locally known as sago palm is a tropical starch crop grown for starch production in commercial plantations in Malaysia, especially in Sarawak, East Malaysia. This plant species accumulate the highest amount of edible starch compared to other starch-producing crops. However, the non-trunking phenomenon has been observed to be one of the major issues restricting the yield of sago palm starch. In this study, proteomics approach was utilised to discover differences between trunking and non-trunking proteomes in sago palm leaf tissues. Total protein from 16 years old trunking and non-trunking sago palm leaves from deep peat area were extracted with PEG fractionation extraction method and subjected to two-dimensional gel electrophoresis (2D PAGE). Differential protein spots were subjected to MALDI-ToF/ToF MS/MS. Proteomic analysis has identified 34 differentially expressed proteins between trunking and non-trunking sago samples. From these protein spots, all 19 proteins representing different enzymes and proteins have significantly increased in abundance in non-trunking sago plant when subjected to mass spectrometry. The identified proteins mostly function in metabolic pathways including photosynthesis, tricarboxylic acid cycle, glycolysis, carbon utilization and oxidative stress. The current study indicated that the several proteins identified through differentially expressed proteome contributed to physical differences in trunking and non-trunking sago palm.
Fulltext Optimal eco-driving scheme for reducing energy consumption and carbon emissions on curved roads

Bakibillah ASM, Kamal MAS, Tan CP, Hayakawa T, Imura JI

Heliyon, 2024 Jan 15;10(1):e23586.
PMID: 38173479 DOI: 10.1016/j.heliyon.2023.e23586

Energy consumption and emissions of a vehicle are highly influenced by road contexts and driving behavior. Especially, driving on horizontal curves often necessitates a driver to brake and accelerate, which causes additional fuel consumption and emissions. This paper proposes a novel optimal ecological (eco) driving scheme (EDS) using nonlinear model predictive control (MPC) considering various road contexts, i.e., curvatures and surface conditions. Firstly, a nonlinear optimization problem is formulated considering a suitable prediction horizon and an objective function based on factors affecting fuel consumption, emissions, and driving safety. Secondly, the EDS dynamically computes the optimal velocity trajectory for the host vehicle considering its dynamics model, the state of the preceding vehicle, and information of road contexts that reduces fuel consumption and carbon emissions. Finally, we analyze the effect of different penetration rates of the EDS on overall traffic performance. The effectiveness of the proposed scheme is demonstrated using microscopic traffic simulations under dense and mixed traffic environment, and it is found that the proposed EDS substantially reduces the fuel consumption and carbon emissions of the host vehicle compared to the traditional (human-based) driving system (TDS), while ensuring driving safety. The proposed scheme can be employed as an advanced driver assistance system (ADAS) for semi-autonomous vehicles.
Fulltext Understanding the role of ACE-2 receptor in pathogenesis of COVID-19 disease: a potential approach for therapeutic intervention

Shirbhate E, Pandey J, Patel VK, Kamal M, Jawaid T, Gorain B, et al.

Pharmacol Rep, 2021 Dec;73(6):1539-1550.
PMID: 34176080 DOI: 10.1007/s43440-021-00303-6

Angiotensin-converting enzyme (ACE) and its homologue, ACE2, are commonly allied with hypertension, renin-angiotensin-aldosterone system pathway, and other cardiovascular system disorders. The recent pandemic of COVID-19 has attracted the attention of numerous researchers on ACE2 receptors, where the causative viral particle, SARS-CoV-2, is established to exploit these receptors for permitting their entry into the human cells. Therefore, studies on the molecular origin and pathophysiology of the cell response in correlation to the role of ACE2 receptors to these viruses are bringing novel theories. The varying level of manifestation and importance of ACE proteins, underlying irregularities and disorders, intake of specific medications, and persistence of assured genomic variants at the ACE genes are potential questions raising nowadays while observing the marked alteration in response to the SARS-CoV-2-infected patients. Therefore, the present review has focused on several raised opinions associated with the role of the ACE2 receptor and its impact on COVID-19 pathogenesis.
Fulltext Expert consensus statement on the science of HIV in the context of criminal law

Barré-Sinoussi F, Abdool Karim SS, Albert J, Bekker LG, Beyrer C, Cahn P, et al.

J Int AIDS Soc, 2018 Jul;21(7):e25161.
PMID: 30044059 DOI: 10.1002/jia2.25161

INTRODUCTION: Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence.
DISCUSSION: Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant.
CONCLUSIONS: The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
Prescribing patterns for upper respiratory tract infections: a prescription-review of primary care practice in Kedah, Malaysia, and the implications

Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, Yusof FA, Kamal M, et al.

Expert Rev Anti Infect Ther, 2015;13(12):1547-56.
PMID: 26358203 DOI: 10.1586/14787210.2015.1085303

INTRODUCTION AND AIMS: It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014.
RESULTS: A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122).
CONCLUSIONS: Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.
KEYWORDS: Malaysia; antibiotics stewardship programs; guidelines; inappropriate use of antibiotics; primary healthcare centres; upper respiratory tract infections
Study site: Klinik kesihatan, Kedah, Malaysia
Fulltext Hepatitis B Core Antigen in Hepatocytes of Chronic Hepatitis B: Comparison between Indirect Immunofluorescence and Immunoperoxidase Method

Raihan R, Tabassum S, Al-Mahtab M, Nessa A, Jahan M, Shamim Kabir CM, et al.

Euroasian J Hepatogastroenterol, 2015 Jan-Jun;5(1):7-10.
PMID: 29201677 DOI: 10.5005/jp-journals-10018-1120

Background: Hepatitis B virus (HBV) infection has many faces. Precore and core promoter mutants resemble inactive carrier status. The identification of hepatitis B core antigen (HBcAg) in hepatocytes may have variable clinical significance. The present study was undertaken to detect HBcAg in chronic hepatitis B (CHB) patients and to assess the efficacy of detection system by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP).

Materials and methods: The study was done in 70 chronic HBV-infected patients. Out of 70 patients, eight (11.4%) were hepatitis B e antigen (HBeAg) positive and 62 (88.57%) were HBeAg negative. Hepatitis B core antigen was detected by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP) methods in liver tissue.

Results: All HBeAg positive patients expressed HBcAg by both IIF and IIP methods. Out of 62 patients with HBeAg-negative CHB, HBcAg was detected by IIF in 55 (88.7%) patients and by IIP in 51 (82.26%) patients. A positive relation among viral load and HBcAg detection was also found. This was more evident in the case of HBeAg negative patients and showed a positive relation with HBV DNA levels.

Conclusion: Hepatitis B core antigen can be detected using the IIF from formalin fixed paraffin block preparation and also by IIP method. This seems to reflect the magnitudes of HBV replication in CHB.

How to cite this article: Raihan R, Tabassum S, Al-Mahtab M, Nessa A, Jahan M, Kabir CMS, Kamal M, Aguilar JC. Hepatitis B Core Antigen in Hepatocytes of Chronic Hepatitis B: Comparison between Indirect Immunofluorescence and Immunoperoxidase Method. Euroasian J Hepato-Gastroenterol 2015;5(1):7-10.
Fulltext Cost-Utility Analysis of Optimal Dosing of Oseltamivir Under Pandemic Influenza Using a Novel Approach: Linking Health Economics and Transmission Dynamic Models

Wu DB, Chaiyakunapruk N, Pratoomsoot C, Lee KK, Chong HY, Nelson RE, et al.

Value Health, 2014 Nov;17(7):A807.
PMID: 27203045 DOI: 10.1016/j.jval.2014.08.527
Cost-utility analysis of antiviral use under pandemic influenza using a novel approach - linking pharmacology, epidemiology and heath economics

Wu DBC, Chaiyakunapruk N, Pratoomsoot C, Lee KKC, Chong HY, Nelson RE, et al.

Epidemiol Infect, 2018 03;146(4):496-507.
PMID: 29446343 DOI: 10.1017/S0950268818000158

Simulation models are used widely in pharmacology, epidemiology and health economics (HEs). However, there have been no attempts to incorporate models from these disciplines into a single integrated model. Accordingly, we explored this linkage to evaluate the epidemiological and economic impact of oseltamivir dose optimisation in supporting pandemic influenza planning in the USA. An HE decision analytic model was linked to a pharmacokinetic/pharmacodynamics (PK/PD) - dynamic transmission model simulating the impact of pandemic influenza with low virulence and low transmissibility and, high virulence and high transmissibility. The cost-utility analysis was from the payer and societal perspectives, comparing oseltamivir 75 and 150 mg twice daily (BID) to no treatment over a 1-year time horizon. Model parameters were derived from published studies. Outcomes were measured as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to examine the integrated model's robustness. Under both pandemic scenarios, compared to no treatment, the use of oseltamivir 75 or 150 mg BID led to a significant reduction of influenza episodes and influenza-related deaths, translating to substantial savings of QALYs. Overall drug costs were offset by the reduction of both direct and indirect costs, making these two interventions cost-saving from both perspectives. The results were sensitive to the proportion of inpatient presentation at the emergency visit and patients' quality of life. Integrating PK/PD-EPI/HE models is achievable. Whilst further refinement of this novel linkage model to more closely mimic the reality is needed, the current study has generated useful insights to support influenza pandemic planning.

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