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Burden of disease associated with cervical cancer in malaysia and potential costs and consequences of HPV vaccination

Aljunid S, Zafar A, Saperi S, Amrizal M

Asian Pac J Cancer Prev, 2010;11(6):1551-9.
PMID: 21338196

BACKGROUND: An estimated 70% of cervical cancers worldwide are attributable to persistent infection with human papillomaviruses (HPV) 16 and 18. Vaccination against HPV 16/18 has been shown to dramatically reduce the incidence of associated precancerous and cancerous lesions. The aims of the present analyses were, firstly, to estimate the clinical and economic burden of disease attributable to HPV in Malaysia and secondly, to estimate long-term outcomes associated with HPV vaccination using a prevalence-based modeling approach.
METHODS: In the first part of the analysis costs attributable to cervical cancer and precancerous lesions were estimated; epidemiologic data were sourced from the WHO GLOBOCAN database and Malaysian national data sources. In the second part, a prevalence-based model was used to estimate the potential annual number of cases of cervical cancer and precancerous lesions that could be prevented and subsequent HPV-related treatment costs averted with the bivalent (HPV 16/18) and the quadrivalent (HPV 16/18/6/11) vaccines, at the population level, at steady state. A vaccine efficacy of 98% was assumed against HPV types included in both vaccines. Effectiveness against other oncogenic HPV types was based on the latest results from each vaccine's respective clinical trials.
RESULTS: In Malaysia there are an estimated 4,696 prevalent cases of cervical cancer annually and 1,372 prevalent cases of precancerous lesions, which are associated with a total direct cost of RM 39.2 million with a further RM 12.4 million in indirect costs owing to lost productivity. At steady state, vaccination with the bivalent vaccine was estimated to prevent 4,199 cervical cancer cases per year versus 3,804 cases for the quadrivalent vaccine. Vaccination with the quadrivalent vaccine was projected to prevent 1,721 cases of genital warts annually, whereas the annual number of cases remained unchanged with the bivalent vaccine. Furthermore, vaccination with the bivalent vaccine was estimated to avert RM 45.4 million in annual HPV-related treatment costs (direct+indirect) compared with RM 42.9 million for the quadrivalent vaccine.
CONCLUSION: This analysis showed that vaccination against HPV 16/18 can reduce the clinical and economic burden of cervical cancer and precancerous lesions in Malaysia. The greatest potential economic benefit was observed using the bivalent vaccine in preference to the quadrivalent vaccine.
Fulltext Cost analysis of psoriasis treatment modalities in Malaysian public hospitals

Azizam, N.A., Saperi, S., Aniza, I., Norazirah, M.N., Azura, M.A., Zafar, A., et al.

Medicine & Health, 2019;14(1):23-33.
MyJurnal

Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient’s cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84% (RM167,439.00) (US$47,862.80) of the total patient’s cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis.
Observational study on patient's satisfactions and quality of life (QoL) among cancer patients receiving treatment with palliative care intent in a tertiary hospital in Malaysia

Sharifa Ezat WP, Fuad I, Hayati Y, Zafar A, Wanda Kiyah GA

Asian Pac J Cancer Prev, 2014;15(2):695-701.
PMID: 24568481

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). The Mental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary (42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care.
Bioequivalence assessment of two enteric-coated aspirin brands, Nu-Seals and Loprin, after a single oral dose of 150 mg in healthy male adults

Bukhari NI, Zafar A, Shamsi Wu, Bashir MA, Mirza AA

Therapie, 2005 Mar-Apr;60(2):167-73.
PMID: 15969319

AIM: The bioequivalence of aspirin from two enteric-coated brands, Nu-seals and Loprin, identified as the reference (R) and test (T) products, respectively, was assessed.

METHODS: A two-period randomised crossover design with a washout interval of 15 days was used in this study. The study results were determined in 16 healthy volunteers, all males with ages ranging from 19-28 (23.33 +/- 3.74) years and bodyweights of 52-92 (65.89 +/- 11.39) kg. After oral ingestion of 150mg of the either brand with 200 mL of water, serial blood samples were obtained over a period of 24 hours. Plasma, harvested from blood was analysed for the concentration of salicylic acid, a deacetylated metabolite of aspirin, by a validated high performance liquid chromatography (HPLC) method. Pharmacokinetic parameters were determined for both formulations by an interactive computer-assisted PK II procedure. A general linear model for repeated measures and 90% confidence intervals (CI) was employed to assess the sequence of treatment effects and to exclude differences between the parameters due to the product and period of administration, respectively.

RESULTS: The observed 90% CI ratios (Loprin/Nu-seals) for peak concentration, time to reach the peak and area under the plasma-concentration time curve from zero to infinity of 1.03,1.08; 1.04,1.05 and 1.01,1.15, respectively, were within the bioequivalence range (0.80,1.25) stipulated by the US Food and Drug Administration.

CONCLUSION: On the basis of the findings, the test (Loprin) and reference drug (Nu-seals) were deemed bioequivalent.
Removal of micropollutants from municipal wastewater using different types of activated carbons

Sher F, Hanif K, Rafey A, Khalid U, Zafar A, Ameen M, et al.

J Environ Manage, 2021 Jan 15;278(Pt 2):111302.
PMID: 33152547 DOI: 10.1016/j.jenvman.2020.111302

The water reservoirs are getting polluted due to increasing amounts of micropollutants such as pharmaceuticals, organic polymers and suspended solids. Powdered activated carbon (PAC) has been proved to be a promising solution for the purification of water without having harmful impacts on the environment. Parameters such as PAC dosing, wastewater hardness, the effect of coagulant and flocculant were evaluated in a batch scale study. These parameters were further applied on a pilot plant scale for the performance evaluation of PAC based removal of micropollutants concerning the contact time and PAC dosing with main focus on recirculation of PAC sludge. The obtained optimum dose was 10-20 mg/L providing 84.40-91.30% removal efficiency of suspended solid micropollutants (MPs) and this efficiency increased to 88.90-93.00% along with coagulant which further raised by the addition of polymer and recirculation process at batch scale. On pilot plant scale, the concentration in contact reactor and PAC removal effectiveness of dissolved air flotation, lamella separator and sedimentation tank were compared. Constant optimisation resulted in a concentration ranging from 2.70 to 3.40 g/L at dosing of PAC 10 mg/L, coagulant 2.00 mg/L and polymer 0.50 mg/L. PAC doses of 10-20 mg/L with 15-30 min contact time proved best for above 70-80% elimination. The recirculation system has also proved an efficient technique because the PAC's adsorption capacity was practically completely used. Small PAC dosages yielded high micropollutants elimination.
Fulltext Improved Ablative Properties of Nanodiamond-Reinforced Carbon Fiber-Epoxy Matrix Composites

Farooq U, Ali MU, Hussain SJ, Ahmad MS, Zafar A, Ghafoor U, et al.

Polymers (Basel), 2021 Jun 22;13(13).
PMID: 34206302 DOI: 10.3390/polym13132035

The influence of nanodiamonds (NDs) on the thermal and ablative performance of carbon-fiber-reinforced-epoxy matrix compositeswas explored. The ablative response of the composites with 0.2 wt% and 0.4 wt% NDs was studied through pre-and post-burning morphologies of the composite surfaces by evaluation of temperature profiles, weight loss, and erosion rate. Composites containing 0.2 wt% NDs displayed a 10.5% rise in erosion resistance, whereas composites containing 0.4 wt% NDs exhibited a 12.6% enhancement in erosion resistance compared to neat carbon fiber-epoxy composites. A similar trend was witnessed in the thermal conductivity of composites. Incorporation of composites with 0.2 wt% and 0.4 wt% NDs brought about an increase of 37 wt% and 52 wt%, respectively. The current study is valuable for the employment of NDs in carbon fiber composite applications where improved erosion resistance is necessary.
Sustainable Hydrates for Enhanced Carbon Dioxide Capture from an Integrated Gasification Combined Cycle in a Fixed Bed Reactor

Abu Hassan MH, Sher F, Fareed B, Ali U, Zafar A, Bilal M, et al.

Ind Eng Chem Res, 2021 Aug 04;60(30):11346-11356.
PMID: 34475634 DOI: 10.1021/acs.iecr.1c01174

An increase in temperature of up to 2 °C occurs when the amount of CO2 reaches a range of 450 ppm. The permanent use of mineral oil is closely related to CO2 emissions. Maintaining the sustainability of fossil fuels and eliminating and reducing CO2 emissions is possible through carbon capture and storage (CCS) processes. One of the best ways to maintain CCS is hydrate-based gas separation. Selected type T1-5 (0.01 mol % sodium dodecyl sulphate (SDS) + 5.60 mol % tetrahydrofuran (THF), with the help of this silica gel promotion was strongly stimulated. A pressure of 36.5 bar of CO2 is needed in H2O to investigate the CO2 hydrate formation. Therefore, ethylene glycol monoethyl ether (EGME at 0.10 mol %) along with SDS (0.01 mol %) labeled as T1A-2 was used as an alternative to THF at the comparable working parameters in which CO2 uptake of 5.45 mmol of CO2/g of H2O was obtained. Additionally, it was found that with an increase in tetra-n-butyl ammonium bromide (TBAB) supplementation of CO2, the hydrate and operating capacity of the process increased. When the bed height was reduced from 3 cm to 2 cm with 0.1 mol % TBAB and 0.01% SDS (labelled as T3-2) in fixed bed reactor (FBR), the outcomes demonstrated a slight expansion in gas supply to 1.54 mmol of CO2/g of H2O at working states of 283 K and 70 bar. The gas selectivity experiment by using the high-pressure volume analysis through hydrate formation was performed in which the highest CO2 uptake for the employment of silica contacts with water in fuel gas mixture was observed in the non-IGCC conditions. Thus, two types of reactor configurations are being proposed for changing the process from batch to continuous with the employment of macroporous silica contacts with new consolidated promoters to improve the formation of CO2 hydrate in the IGCC conditions. Later, much work should be possible on this with an assortment of promoters and specific performance parameters. It was reported in previous work that the repeatability of equilibrium moisture content and gas uptake attained for the sample prepared by the highest rates of stirring was the greatest with the CIs of ±0.34 wt % and ±0.19 mmol of CO2/g of H2O respectively. This was due to the amount of water occluded inside silica gel pores was not an issue or in other words, vigorous stirring increased the spreadability. The variation of pore size to improve the process can be considered for future work.
Fulltext Predicting the Ultimate Axial Capacity of Uniaxially Loaded CFST Columns Using Multiphysics Artificial Intelligence

Khan S, Ali Khan M, Zafar A, Javed MF, Aslam F, Musarat MA, et al.

Materials (Basel), 2021 Dec 22;15(1).
PMID: 35009186 DOI: 10.3390/ma15010039

The object of this research is concrete-filled steel tubes (CFST). The article aimed to develop a prediction Multiphysics model for the circular CFST column by using the Artificial Neural Network (ANN), the Adaptive Neuro-Fuzzy Inference System (ANFIS) and the Gene Expression Program (GEP). The database for this study contains 1667 datapoints in which 702 are short CFST columns and 965 are long CFST columns. The input parameters are the geometric dimensions of the structural elements of the column and the mechanical properties of materials. The target parameters are the bearing capacity of columns, which determines their life cycle. A Multiphysics model was developed, and various statistical checks were applied using the three artificial intelligence techniques mentioned above. Parametric and sensitivity analyses were also performed on both short and long GEP models. The overall performance of the GEP model was better than the ANN and ANFIS models, and the prediction values of the GEP model were near actual values. The PI of the predicted Nst by GEP, ANN and ANFIS for training are 0.0416, 0.1423, and 0.1016, respectively, and for Nlg these values are 0.1169, 0.2990 and 0.1542, respectively. Corresponding OF values are 0.2300, 0.1200, and 0.090 for Nst, and 0.1000, 0.2700, and 0.1500 for Nlg. The superiority of the GEP method to the other techniques can be seen from the fact that the GEP technique provides suitable connections based on practical experimental work and does not rely on prior solutions. It is concluded that the GEP model can be used to predict the bearing capacity of circular CFST columns to avoid any laborious and time-consuming experimental work. It is also recommended that further research should be performed on the data to develop a prediction equation using other techniques such as Random Forest Regression and Multi Expression Program.
Fulltext Bio-inspired based meta-heuristic approach for predicting the strength of fiber-reinforced based strain hardening cementitious composites

Khan Y, Zafar A, Rehman MF, Javed MF, Iftikhar B, Gamil Y

Heliyon, 2023 Nov;9(11):e21601.
PMID: 38027981 DOI: 10.1016/j.heliyon.2023.e21601

A recently introduced bendable concrete having hundred times greater strain capacity provides promising results in repair of engineering structures, known as strain hardening cementitious composites (SHHCs). The current research creates new empirical prediction models to assess the mechanical properties of strain-hardening cementitious composites (SHCCs) i.e., compressive strength (CS), first crack tensile stress (TS), and first crack flexural stress (FS), using gene expression programming (GEP). Wide-ranging records were considered with twelve variables i.e., cement percentage by weight (C%), fine aggregate percentage by weight (Fagg%), fly-ash percentage by weight (FA%), Water-to-binder ratio (W/B), super-plasticizer percentage by weight (SP%), fiber amount percentage by weight (Fib%), length to diameter ratio (L/D), fiber tensile strength (FTS), fiber elastic modulus (FEM), environment temperature (ET), and curing time (CT). The performance of the models was deduced using correlation coefficient (R) and slope of regression line. The established models were also assessed using relative root mean square error (RRMSE), Mean absolute error (MAE), Root squared error (RSE), root mean square error (RMSE), objective function (OBF), performance index (PI) and Nash-Sutcliffe efficiency (NSE). The resulting mathematical GP-based equations are easy to understand and are consistent disclosing the originality of GEP model with R in the testing phase equals to 0.8623, 0.9269, and 0.8645 for CS, TS and FS respectively. The PI and OBF are both less than 0.2 and are in line with the literature, showing that the models are free from overfitting. Consequently, all proposed models have high generalization with less error measures. The sensitivity analysis showed that C%, Fagg%, and ET are the most significant variables for all three models developed with sensitiveness index higher than 10 %. The result of the research can assist researchers, practitioners, and designers to assess SHCC and will lead to sustainable, faster, and safer construction from environment-friendly waste management point of view.
Box-Behnken supported development and validation of robust HPTLC method: an application in estimation of punarnavine in leaf, stem, and their callus of Boerhavia diffusa Linn

Ahmad W, Husain I, Ahmad N, Amir M, Sarafroz M, Ansari MA, et al.

3 Biotech, 2020 Apr;10(4):165.
PMID: 32206499 DOI: 10.1007/s13205-020-2154-1

Boerhavia diffusa (BD) Linn. (Nyctaginaceae) is one of the most commonly used herbs in the Indian traditional system of medicine for the urinary disorders. The aim of the current investigation was to carry out initiation, development, and maintenance of BD callus cultures and quantitative estimation of punarnavine in plant and callus extracts. Leaves and stem of BD were used as explant for the tissue culture studies using Murashige and Skoog (MS) basal medium. MS Media comprising 2,4-Dichlorophenoxy acetic acid (2,4-D) (1 ppm) and 2,4-D (1 ppm) + Indole-3-acetic acid (IAA) (1.0 ppm) were found to yield friable callus from leaf explant; similarly, 2,4-D (0.3 ppm) + IAA (0.75 ppm) + Kinetin (0.3 ppm) and 2,4-D (0.5 ppm) + Naphthalene acetic acid (NAA) (1.5 ppm) + Kinetin (0.3 ppm) were found to yield friable callus from the stem explant. High-performance thin-layer chromatography method was been developed for the quantitative estimation of punarnavine (Rf = 0.73) using mobile phase containing toluene: ethyl acetate: formic acid in the ratio (7.0:2.5:0.7, v/v/v) at 262 nm. The validated method was found linear (r2 = 0.9971) in a wide range (100-1000 ng spot-1), precise, accurate, and robust. The values of limit of detection, LOD = 30.3 ng spot-1, and limit of quantification, LOQ = 100.0 ng spot-1. The robustness of the method was proved by applying the Box-Behnken design (BBD). The developed method found appropriate for the quality control of medicinal plants containing punarnavine as a constituent.
Skeletal-related events among breast and prostate cancer patients: towards new treatment initiation in Malaysia's hospital setting

Ezat SW, Syed Junid SM, Noraziani K, Zafar A, Saperi S, Nur AM, et al.

Asian Pac J Cancer Prev, 2013;14(5):3357-62.
PMID: 23803129

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient health- related quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.
Fulltext Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology

Saleem Z, Faller EM, Godman B, Malik MSA, Iftikhar A, Iqbal S, et al.

Med Access Point Care, 2021 12 16;5:23992026211064714.
PMID: 36204499 DOI: 10.1177/23992026211064714

Background: Antibiotics are losing their effectiveness because of the rapid emergence of resistant bacteria. Unnecessary antimicrobial use increases antimicrobial resistance (AMR). There are currently no published data on antibiotic consumption in Pakistan at the community level. This is a concern given high levels of self-purchasing of antibiotics in Pakistan and variable knowledge regarding antibiotics and AMR among physicians and pharmacists.
Objective: The objective of this repeated prevalence survey was to assess the pattern of antibiotic consumption data among different community pharmacies to provide a baseline for developing future pertinent initiatives.
Methods: A multicenter repeated prevalence survey conducted among community pharmacies in Lahore, a metropolitan city with a population of approximately 10 million people, from October to December 2017 using the World Health Organization (WHO) methodology for a global program on surveillance of antimicrobial consumption.
Results: The total number of defined daily doses (DDDs) dispensed per patient ranged from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin with a total number of 486.6 DDDs and azithromycin with a total number of 472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime, amikacin, and ofloxacin, with overall consumption highest in December.
Conclusion: The study indicated high antibiotic usage among community pharmacies in Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly dispensed inappropriately. The National action plan of Pakistan on AMR should be implemented by policymakers including restrictions on the dispensing of antimicrobials.
Pattern of first- and second-line drug resistance among pulmonary tuberculosis retreatment cases in Pakistan

Javaid A, Hasan R, Zafar A, Chaudry MA, Qayyum S, Qadeer E, et al.

Int J Tuberc Lung Dis, 2017 03 01;21(3):303-308.
PMID: 28225340 DOI: 10.5588/ijtld.16.0444

BACKGROUND: Drug resistance in general, and multidrug-resistant tuberculosis (MDR-TB) in particular, threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Pakistan.
OBJECTIVE: To obtain population-based data on Mycobacterium tuberculosis drug resistance in Pakistan.
METHODS: To obtain drug resistance data, we conducted a population-based study of TB cases in all provinces of Pakistan. We performed culture and drug susceptibility testing on M. tuberculosis isolates from patients with a prior history of anti-tuberculosis treatment (retreatment cases) from all over the country.
RESULTS: Of 544 isolates from previously treated cases, 289 (53.1%) were susceptible to all first-line drugs, 255 (46.9%) were resistant to at least one anti-tuberculosis drug and 132 (24.3%) were MDR-TB. Among MDR-TB isolates, 47.0% were ofloxacin (OFX) resistant. Extensively drug-resistant TB was found in two (0.4%) isolates.
CONCLUSION: Prevalence of drug resistance in retreatment isolates was high. The alarmingly high prevalence of OFX resistance among MDR-TB isolates may threaten the success of efforts to control and treat MDR-TB.
Fulltext Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care

Kalra S, Czupryniak L, Kilov G, Lamptey R, Kumar A, Unnikrishnan AG, et al.

Diabetes Ther, 2018 Dec;9(6):2185-2199.
PMID: 30390228 DOI: 10.1007/s13300-018-0521-2

Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.

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