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Letter to the Editor: Research and consensus is required concerning integrity of randomized clinical trials

Khan KS, Chien PFW

Int J Gynaecol Obstet, 2022 11;159(2):613.
PMID: 36030408 DOI: 10.1002/ijgo.14394
Fulltext Systematic Review Reporting - Writing concisely and precisely

Chien PF, Khan KS

Pak J Med Sci, 2023;39(2):317-322.
PMID: 36950392 DOI: 10.12669/pjms.39.2.7428

Systematic reviews rank at the top of the evidence hierarchy. Concise writing implies drafting the systematic review article succinctly, i.e. using as few words to express as full an extent of the research effort as possible. Precise writing means drafting the text with accuracy especially with respect to the methodological and statistical aspects. The Abstract ought to be succinct and structured to allow for editors, peer reviewers and readers to get the gist of the key aspects of the systematic review with a quick read. The readership needs to be able to critically appraisal systematic reviews for their internal and external validity rapidly. The Abstract also needs to be standalone, representing an independent summary that can be fully understood without the need for reading the full paper. The standard structure of the main text of a scientific article called IMRaD (Introduction, Methods, Results and Discussion) applies equally to systematic reviews in the same way as it does to any other kinds of research manuscripts whether related to laboratory experiments or clinical trials. Restricting the word count limits to those imposed by journals may at first seem difficult, even unfair, to systematic reviewers. However, with the availability of online appendices to transparently and fully report the details of the methods, results and other aspects of the work undertaken allows for a succinct print or PDF article. Writing a shorter manuscript is more effortful than writing a longer report. This commentary is aimed at novice systematic reviewers to help them learn the written and unwritten writing rules in order to assist them in producing impactful publications to support evidence-based medicine.
Integrity of randomized clinical trials: Performance of integrity tests and checklists requires assessment

Khan KS, Fawzy M, Chien PFW

Int J Gynaecol Obstet, 2023 Dec;163(3):733-743.
PMID: 37184087 DOI: 10.1002/ijgo.14837

The integrity of randomized clinical trials (RCT) has become a concern owing to a recent rise in the number of retractions and the repercussions this has for evidence-based patient care. However, there is little research on the subject of RCT integrity assessment. Recent literature reviews have revealed that journals' authors' instructions concerning integrity and their investigation policies concerning allegations of misconduct are heterogeneous. The judicious use of integrity tests applied to RCT manuscripts is hampered by an absence of data concerning misconduct prevalence (pre-test probability), a failure to evaluate test performance (validity) and a lack of consensus over a gold standard (against which test accuracy can be evaluated). These deficiencies hinder the post-publication correction of RCT records, the integrity evaluations in systematic reviews of RCTs and the prospective application of preventive solutions in RCT peer-review and preprint assessment. Dealing with the current controversy about trustworthiness of RCT evidence requires a strong investment in research, reform and education concerning research integrity. The purpose of this review article is to highlight the current limitations in dealing with trial integrity-related concerns and to propose solutions to some of these issues.
Fulltext Human CD3+ T-Cells with the Anti-ERBB2 Chimeric Antigen Receptor Exhibit Efficient Targeting and Induce Apoptosis in ERBB2 Overexpressing Breast Cancer Cells

Munisvaradass R, Kumar S, Govindasamy C, Alnumair KS, Mok PL

Int J Mol Sci, 2017 Sep 08;18(9).
PMID: 28885562 DOI: 10.3390/ijms18091797

Breast cancer is a common malignancy among women. The innate and adaptive immune responses failed to be activated owing to immune modulation in the tumour microenvironment. Decades of scientific study links the overexpression of human epidermal growth factor receptor 2 (ERBB2) antigen with aggressive tumours. The Chimeric Antigen Receptor (CAR) coding for specific tumour-associated antigens could initiate intrinsic T-cell signalling, inducing T-cell activation, and cytotoxic activity without the need for major histocompatibility complex recognition. This renders CAR as a potentially universal immunotherapeutic option. Herein, we aimed to establish CAR in CD3+ T-cells, isolated from human peripheral blood mononucleated cells that could subsequently target and induce apoptosis in the ERBB2 overexpressing human breast cancer cell line, SKBR3. Constructed CAR was inserted into a lentiviral plasmid containing a green fluorescent protein tag and produced as lentiviral particles that were used to transduce activated T-cells. Transduced CAR-T cells were then primed with SKBR3 cells to evaluate their functionality. Results showed increased apoptosis in SKBR3 cells co-cultured with CAR-T cells compared to the control (non-transduced T-cells). This study demonstrates that CAR introduction helps overcome the innate limitations of native T-cells leading to cancer cell apoptosis. We recommend future studies should focus on in vivo cytotoxicity of CAR-T cells against ERBB2 expressing tumours.
Fulltext Recurrent vomiting in a woman due to miscarriage: think out of the box

Khalid S, Aris MS

BMJ Case Rep, 2016 Mar 30;2016.
PMID: 27030452 DOI: 10.1136/bcr-2015-213165

A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.
Fulltext The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows

Khalid S, Dixon S, Vijayasingham L

Soc Sci Med, 2022 Jan;293:114665.
PMID: 34954676 DOI: 10.1016/j.socscimed.2021.114665

There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.
Unexpected sequelae of plantar fasciitis: Iatrogenic calcaneal osteomyelitis following plantar heel injection

Mohd Khalid SA, Bajuri MY

Malays Fam Physician, 2019;14(3):80-83.
PMID: 32175048

The injection of a local anesthetic in combination with a corticosteroid is an accepted choice in the treatment of plantar fasciitis with recalcitrant heel pain. When the injection is performed properly, post-injection infection is extremely rare. We are reporting a rare case of chronic calcaneal osteomyelitis that developed secondary to a local corticosteroid injection. A 56-year-old lady diagnosed with right plantar fasciitis presented with a 6-month history of pain and a persistent sinus with serous discharge of her right heel following a local infiltration of a corticosteroid. A Magnetic Resonance Imaging demonstrated right calcaneal osteomyelitis with intramuscular abscess. Surgical drainage and debridement were done, followed by antibiotic therapy. A recurrence of infection was not detected throughout the duration of follow-up. It is suggested that a plantar heel injection be done in a more controlled environment, such as in operating theatre, to reduce the risk of infection and to avoid injecting a steroid as compared to platelet-rich plasma (PRP) in view of their safety profiles. However, such an injection should only be offered after conservative treatment has failed, as 80% of patients recover well after initial conservative management.
Fulltext Prevalence and associated factors of burnout among family medicine residents in Al Madina, Saudi Arabia

Aldubai SAR, Aljohani AM, Alghamdi AG, Alghamdi KS, Ganasegeran K, Yenbaawi AM

J Family Med Prim Care, 2019 02;8(2):657-662.
PMID: 30984690 DOI: 10.4103/jfmpc.jfmpc_268_18

Background and Aim: Burnout is a common problem for interns and residents. It has been associated with physical and mental health of health care providers as well as low job satisfaction and medical errors. Few studies have investigated this problem among residents. This study aimed to determine the prevalence of burnout and its associated factors among family residents in Al Madina city, Saudi Arabia.
Materials and Methods: This cross-sectional study was conducted among 75 residents in the family medicine residency programs in Al Madina, Saudi Arabia. A self-administered questionnaire was used that includes questions on sociodemographic characteristics and sources of stress and burnout. T test, analysis of variance (ANOVA) test, and multiple linear regression analysis were employed.
Results: Majority were female (54.7%) and aged 26 to 30 years (84.0%). The significant predictors of burnout in the final model were "tests/examinations" (P = 0.014), "large amount of content to be learnt" (P = 0.016), "unfair assessment from superiors" (P = 0.001), "work demands affect personal/home life" (P = 0.001), and "lack of support from superiors" (P = 0.006).
Conclusion: Burnout is present among family medicine residents at a relatively high percentage. This situation is strongly triggered by work-related stressors, organizational attributes, and system-related attributes, but not socio-demographics of the respondents. Systemic changes to relieve the workload of family medicine residents are recommended to promote effective management of burnout.
Study of Primordial 226Ra, 228Ra, and 40K Concentrations in Dietary Palm Dates and Concomitant Radiological Risk

Khandaker MU, Shuaibu HK, Alklabi FAA, Alzimami KS, Bradley DA

Health Phys, 2019 06;116(6):789-798.
PMID: 30889102 DOI: 10.1097/HP.0000000000001042

The presence of natural radionuclides in the food chain point to a need to assess concentration levels and concomitant radiological risk. Highly popular and forming a staple part of the diet in North Africa, the Arabian Peninsula, and West Asia, palm dates growing naturally there have even greater marketability than simple satisfaction of domestic demand, the palm dates representing a valuable export item. Accurate knowledge of the levels of natural radioactivity in the fruit is thus of importance. In this study, using high-purity germanium gamma-ray spectrometry, quantification has been made of natural radionuclide concentrations in imported dates originating from Iran, Saudi Arabia, and Tunisia. Sample analyses reveal respective mean activity concentrations of 1.4 ± 0.3, 0.8 ± 0.4, and 186 ± 9 Bq kg dry weight for Ra, Ra, and K. For each nuclide, the mean concentration varies little between the dates of the three represented regions. The estimated committed effective dose resulting from the consumption of date fruits for a typical adult was found to be 29.9 μSv y, well below the global internal dose of 290 μSv y assessed by the United Nations Scientific Committee on the Effects of Atomic Radiation to be due to food and water intake. Similarly, the excess lifetime cancer risk due to naturally occurring radioactive material exposure via date fruit consumption is seen to be below the International Commission on Radiological Protection cancer risk factor of 2.5 × 10 based on the additional annual dose limit of 1 mSv for a member of the general public. The results show no significant uptake in the analyzed date fruits.
Phytoremediation of bauxite wastewater potentiality by Jatropa curcas

Kristanti RA, Mardarveran P, Almaary KS, Elshikh MS, AbdelGawwad MR, Tang DKH

Bioprocess Biosyst Eng, 2023 Mar;46(3):373-379.
PMID: 35773493 DOI: 10.1007/s00449-022-02745-5

Bauxite wastewater creates soil contamination and produces toxic effects on human health such as respiratory and skin rash problems. In this study, we investigated the phytoremediation ability of Jatropha curcas to remove bauxite wastewater from soil. Pot experiments were conducted to investigate the bauxite wastewater on the phytoremediation potential of J. curcas grown in contaminated soils. J. curcas exhibited a significant increase in plant growth leaf, root activity, plant height, and plant shoot when grown in bauxite contaminated soils compared with J. curcas grown in uncontaminated soils after 30 d treatment. Under bauxite exposure, a higher aluminium removal (88.5%) was observed in soils planted with J. curcas than unplanted soils (39.6%). The bioconcentration factor was also found to be 5.62, indicating that J. curcas have great tolerance and hyperaccumulator of aluminium under high aluminium concentrations and are capable of phytoextraction of soil contaminated with bauxite wastewater.
Fulltext Risks of stillbirth and neonatal death with advancing gestation at term: A systematic review and meta-analysis of cohort studies of 15 million pregnancies

Muglu J, Rather H, Arroyo-Manzano D, Bhattacharya S, Balchin I, Khalil A, et al.

PLoS Med, 2019 07;16(7):e1002838.
PMID: 31265456 DOI: 10.1371/journal.pmed.1002838

BACKGROUND: Despite advances in healthcare, stillbirth rates remain relatively unchanged. We conducted a systematic review to quantify the risks of stillbirth and neonatal death at term (from 37 weeks gestation) according to gestational age.
METHODS AND FINDINGS: We searched the major electronic databases Medline, Embase, and Google Scholar (January 1990-October 2018) without language restrictions. We included cohort studies on term pregnancies that provided estimates of stillbirths or neonatal deaths by gestation week. We estimated the additional weekly risk of stillbirth in term pregnancies that continued versus delivered at various gestational ages. We compared week-specific neonatal mortality rates by gestational age at delivery. We used mixed-effects logistic regression models with random intercepts, and computed risk ratios (RRs), odds ratios (ORs), and 95% confidence intervals (CIs). Thirteen studies (15 million pregnancies, 17,830 stillbirths) were included. All studies were from high-income countries. Four studies provided the risks of stillbirth in mothers of White and Black race, 2 in mothers of White and Asian race, 5 in mothers of White race only, and 2 in mothers of Black race only. The prospective risk of stillbirth increased with gestational age from 0.11 per 1,000 pregnancies at 37 weeks (95% CI 0.07 to 0.15) to 3.18 per 1,000 at 42 weeks (95% CI 1.84 to 4.35). Neonatal mortality increased when pregnancies continued beyond 41 weeks; the risk increased significantly for deliveries at 42 versus 41 weeks gestation (RR 1.87, 95% CI 1.07 to 2.86, p = 0.012). One additional stillbirth occurred for every 1,449 (95% CI 1,237 to 1,747) pregnancies that advanced from 40 to 41 weeks. Limitations include variations in the definition of low-risk pregnancy, the wide time span of the studies, the use of registry-based data, and potential confounders affecting the outcome.
CONCLUSIONS: Our findings suggest there is a significant additional risk of stillbirth, with no corresponding reduction in neonatal mortality, when term pregnancies continue to 41 weeks compared to delivery at 40 weeks.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015013785.
Radioluminescence sensing of radiology exposures using P-doped silica optical fibres

Bradley DA, Zubair HT, Oresegun A, Louay GT, Ariffin A, Khandaker MU, et al.

Appl Radiat Isot, 2018 Nov;141:176-181.
PMID: 29673719 DOI: 10.1016/j.apradiso.2018.02.025

In previous work we investigated the real-time radioluminescence (RL) yield of Ge-doped silica fibres and Al2O3 nanodot media, sensing electron- and x-ray energies and intensities at values familiarly obtained in external beam radiotherapy. The observation of an appreciable low-dose sensitivity has given rise to the realisation that there is strong potential for use of RL dosimetry in diagnostic radiology. Herein use has been made of P-doped silica optical fibre, 2 mm diameter, also including a 271 µm cylindrical doped core. With developing needs for versatile x-ray imaging dosimetry, preliminary investigations have been made covering the range of diagnostic x-ray tube potentials 30 kVp to 120 kVp, demonstrating linearity of RL with kVp as well as in terms of the current-time (mAs) product. RL yields also accord with the inverse-square law. Given typical radiographic-examination exposure durations from tens- to a few hundred milliseconds, particular value is found in the ability to record the influence of x-ray generator performance on the growth and decay of beam intensity, from initiation to termination.
Occurrence of extended-spectrum β-lactamase, AmpC, and carbapenemase-producing genes in gram-negative bacterial isolates from human immunodeficiency virus infected patients

Rameshkumar MR, Arunagirinathan N, Senthamilselvan B, Swathirajan CR, Solomon SS, Vignesh R, et al.

J Infect Public Health, 2021 Nov 10.
PMID: 34810142 DOI: 10.1016/j.jiph.2021.11.008

BACKGROUND: Progressive decline of immune response in HIV patients makes them susceptible to frequent bacterial infections. High usage of antibiotics influences the emergence of multidrug-resistant bacteria and worsens the clinical outcomes. In this study, the occurrence of drug-resistant genes in Gram-negative bacterial isolates from HIV patients in South India was analyzed.
METHODS: A total of 173 Gram-negative bacterial (GNB) isolates from HIV patients were screened for antibiotic susceptibility profile using the Kirby-Bauer diskdiffusion method. Positivity of drug-resistant genes was analyzed using polymerase chain reaction method.
RESULTS: In this study, 72.8% of bacterial isolates were obtained from urine specimens, and Escherichia coli (47.4%) was the predominantly isolated bacterium. Overall, 87.3% and 83.2% of GNB were resistant to 3rd generation cephalosporin antibiotics such as cefotaxime and ceftazidime, respectively, 56.6% were resistant to cephamycin (cefoxitin) and 43% to carbapenem (imipenem) antibiotics. Extended-spectrum β-lactamases (ESBL) production was noted among 79.5% of GNB isolates, followed by AmpC (57.1%) and Metallo β-lactamases (37.3%). Molecular analysis revealed that ESBL genes such as blaTEM (94.1%), blaCTX-M (89.2%), and blaSHV (24.2%) were detected at higher levels among GNB isolates. Carbapenemase-producing genes such as blaOXA-48 (20%), blaOXA-23 (2.6%), and both blaOXA-23 and blaOXA-51 like genes (2.6%) and AmpC producing genes such as blaCIT (26.7%), blaDHA (3.6%), and blaACC (1.8%) were detected at low-level.
CONCLUSIONS: This study concludes that ESBL producing genes are detected at high level among gram-negative bacterial isolates from HIV patients in South India.
Research integrity in randomized clinical trials: A scoping umbrella review

Núñez-Núñez M, Maes-Carballo M, Mignini LE, Chien PFW, Khalaf Y, Fawzy M, et al.

Int J Gynaecol Obstet, 2023 Sep;162(3):860-876.
PMID: 37062861 DOI: 10.1002/ijgo.14762

BACKGROUND: Randomized clinical trials (RCTs) are experiencing a crisis of confidence in their trustworthiness. Although a comprehensive literature search yielded several reviews on RCT integrity, an overarching overview is lacking.
OBJECTIVES: The authors undertook a scoping umbrella review of the research integrity literature concerning RCTs.
SEARCH STRATEGY AND SELECTION CRITERIA: Following prospective registration (https://osf.io/3ursn), two reviewers independently searched PubMed, Scopus, The Cochrane Library, and Google Scholar, without language or time restrictions, until November 2021. The authors included systematic reviews covering any aspect of research integrity throughout the RCT lifecycle.
DATA COLLECTION AND ANALYSIS: The authors assessed methodological quality using a modified AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool and collated the main findings.
MAIN RESULTS: A total of 55 relevant reviews, summarizing 6001 studies (median per review, 63; range, 8-1106) from 1964 to 2021, had an overall critically low quality of 96% (53 reviews). Topics covered included general aspects (15%), design and approval (22%), conduct and monitoring (11%), reporting (38%), postpublication concerns (2%), and future research (13%). The most common integrity issues covered were ethics (18%) and transparency (18%).
CONCLUSIONS: Low-quality reviews identified various integrity issues across the RCT lifecycle, emphasizing the importance of high ethical standards and professionalism while highlighting gaps in the integrity landscape. Multistakeholder consensus is needed to develop specific RCT integrity standards.
Fulltext Corrigendum to "In Vitro Wound Healing Potential of Stem Extract of Alternanthera sessilis"

Muniandy K, Gothai S, Tan WS, Kumar SS, Esa NM, Chandramohan G, et al.

Evid Based Complement Alternat Med, 2020;2020:2705479.
PMID: 32617103 DOI: 10.1155/2020/2705479

[This corrects the article DOI: 10.1155/2018/3142073.].
Fulltext In Vitro Wound Healing Potential of Stem Extract of Alternanthera sessilis

Muniandy K, Gothai S, Tan WS, Kumar SS, Mohd Esa N, Chandramohan G, et al.

Evid Based Complement Alternat Med, 2018;2018:3142073.
PMID: 29670658 DOI: 10.1155/2018/3142073

Impaired wound healing is one of the serious problems among the diabetic patients. Currently, available treatments are limited due to side effects and cost effectiveness. In line with that, we attempted to use a natural source to study its potential towards the wound healing process. Therefore, Alternanthera sessilis (A. sessilis), an edible and medicinal plant, was chosen as the target sample for the study. During this investigation, the wound closure properties using stem extract of A. sessilis were analyzed. Accordingly, we analyzed the extract on free radical scavenging capacity and the cell migration of two most prominent cell types on the skin, human dermal fibroblast (NHDF), keratinocytes (HaCaT), and diabetic human dermal fibroblast (HDF-D) to mimic the wound healing in diabetic patients. The bioactive compounds were identified using gas chromatography-mass spectrometry (GC-MS). We discovered that the analysis exhibited a remarkable antioxidant, proliferative, and migratory rate in NHDF, HaCaT, and HDF-D in dose-dependent manner, which supports wound healing process, due to the presence of wound healing associated phytocompounds such as Hexadecanoic acid. This study suggested that the stem extract of A. sessilis might be a potential therapeutic agent for skin wound healing, supporting its traditional medicinal uses.
Post-publication research integrity concerns in randomized clinical trials: A scoping review of the literature

Chien PFW, Elsuity MA, Rashwan MM, Núñez-Núñez M, Khan KS, Zamora-Romero J, et al.

Int J Gynaecol Obstet, 2024 Sep;166(3):984-993.
PMID: 38571333 DOI: 10.1002/ijgo.15488

BACKGROUND: Post-publication handling of integrity concerns in randomized clinical trials (RCTs) is a contentious matter.
OBJECTIVES: We undertook a scoping systematic review to map the literature regarding post-publication integrity issues in RCTs.
SEARCH STRATEGY AND SELECTION CRITERIA: Following prospective registration (https://osf.io/pgxd8) we initially searched PubMed and Scopus but subsequently extended it to include the Cochrane Library, and Google Scholar databases without language, article type or publication time restriction until November 2022. Reviewers independently selected published articles covering any aspect of post-publication research integrity concerns in RCTs.
DATA COLLECTION AND ANALYSIS: The study findings grouped within domains relating to issues concerning post-publication integrity were extracted in duplicate, verified by a third reviewer, and then tabulated.
MAIN RESULTS: The initial search captured 3159 citations, of which 89 studies were included in the review. Cross-sectional studies constituted the majority of included studies (n = 34, 38.2%), followed by systematic reviews (n = 10, 11.2%), methodology reviews/studies (n = 9, 10.1%) and other types of descriptive studies (n = 8, 9.0%). A total of 21 articles (23.6%) covered the domain on general issues, 25 (28.1%) in the journal's instructions and policies domain, eight (9.0%) in the editorial and peer review domain, one (1.1%) in the correspondence and complaints (post-publication peer review) domain, 12 (13.5%) in the investigation for concerns domain, six (6.7%) in the post-investigation decisions and sanctions domain, none in the critical appraisal guidance domain, five (5.6%) in the integrity assessment in systematic reviews domain, and 26 (29.2%) in the recommendations for future research domain. A total of 12 of the selected articles (13.5%) covered two (n = 9) or three (n = 3) different domains.
CONCLUSIONS: Various research integrity domains and issues covering post-publication aspects of RCT integrity were captured and gaps were identified, mostly related with the necessary implications for all stakeholders to improve research transparency. There is an urgent need for a multistakeholder consensus towards creating specific statements for addressing post-publication integrity concerns in RCTs.
Fulltext A Pharmacoeconomic Care Analysis of Tuberculosis Control in Pakistan

Iqbal MS, Iqbal MW, Bahari MB, Khalid SH, Iqbal MZ

Value Health, 2014 Nov;17(7):A594.
PMID: 27202039 DOI: 10.1016/j.jval.2014.08.2044
Experimental investigation on the use of highly charged nanoparticles to improve the stability of weakly charged colloidal system

Zubir MN, Badarudin A, Kazi SN, Misran M, Amiri A, Sadri R, et al.

J Colloid Interface Sci, 2015 Sep 15;454:245-55.
PMID: 26048724 DOI: 10.1016/j.jcis.2015.05.019

The present work highlighted on the implementation of a unique concept for stabilizing colloids at their incipiently low charge potential. A highly charged nanoparticle was introduced within a coagulated prone colloidal system, serving as stabilizer to resist otherwise rapid flocculation and sedimentation process. A low size asymmetry of nanoparticle/colloid serves as the new topic of investigation in addition to the well-established large size ratio nanoparticle/microparticle study. Highly charged Al2O3 nanoparticles were used within the present research context to stabilize TiO2 and Fe3O4 based colloids via the formation of composite structures. It was believed, based on the experimental evidence, that Al2O3 nanoparticle interact with the weakly charged TiO2 and Fe3O4 colloids within the binary system via absorption and/or haloing modes to increase the overall charge potential of the respective colloids, thus preventing further surface contact via van der Waal's attraction. Series of experimental results strongly suggest the presence of weakly charged colloids in the studied bimodal system where, in the absence of highly charged nanoparticle, experience rapid instability. Absorbance measurement indicated that the colloidal stability drops in accordance to the highly charged nanoparticle sedimentation rate, suggesting the dominant influence of nanoparticles to attain a well-dispersed binary system. Further, it was found that the level of colloidal stability was enhanced with increasing nanoparticle fraction within the mixture. Rheological observation revealed that each hybrid complexes demonstrated behavior reminiscence to water with negligible increase in viscosity which serves as highly favorable condition particularly in thermal transport applications.
Evaluation of golden percentage in natural maxillary anterior teeth width: A systematic review

Ahmed N, Halim MS, Khalid S, Ghani ZA, Jamayet NB

J Prosthet Dent, 2021 Jul 31.
PMID: 34340826 DOI: 10.1016/j.prosdent.2021.06.015

STATEMENT OF PROBLEM: The color and form of teeth are 2 of the 3 main determinants of success in an esthetic restoration; the third is dental proportion. A recent systematic review of the literature devoted to the evaluation of dental proportion is lacking.
PURPOSE: The purpose of this systematic review was to investigate the quality and outcome of studies into maxillary anterior tooth proportion and to determine whether dental proportion ratios based on different geographic regions are appropriate.
MATERIAL AND METHODS: An electronic search was conducted using PubMed, MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, Web of Science, and Science Direct databases. English-language articles reporting with the specific combination of medical subject heading (MeSH) key words were analyzed by 2 investigators. The titles, full text, and abstracts were scanned by investigators independently to identify articles that fulfilled the inclusion criteria. The general characteristics, outcomes, and quality of each study were reviewed and analyzed systematically.
RESULTS: The search plan resulted in a total of 73 articles until September 2020; of which, 16 articles fulfilling the inclusion criteria were selected. The geographic distribution of the selected article revealed 12 articles from Asia, 2 from Continental Europe, and 2 from the United Kingdom. Golden percentage values of 25%, 15%, and 10% for central, lateral incisor, and canine teeth were not found. The mean predicted dental percentage was either larger or smaller than the successive widths of maxillary natural anterior teeth.
CONCLUSIONS: The golden percentage could not be used to formulate a smile design. Rather, the dental ratios should be set on a racial and ethnic basis for a population.

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