Highly efficient mica-incorporated graphene oxide-based membranes for water purification and desalination.

Graphene oxide (GO) has become the most attractive material for membrane technology owing to its potential application as a nanofiller in water treatment, purification, and desalination. In this study, we incorporated mica as a cross-linking reagent to increase the interlayer spacing and stability of GO sheets and fabricated a mica/GO (MGO) membrane for the first time. The MGO membrane (260 ± 10 nm) exhibits 100% rejection for biomolecules such as tannic acid (TA) and bovine serum albumin (BSA) and >99% rejection for multiple probe molecules, such as methylene blue, methyl orange, congo red, and rhodamine B. The high rejection of membranes can be attributed to the surface interaction of mica with GO nanosheets through covalent interaction, which enhances the stability and separation efficiency of the membranes for probe ions and molecules. This ultrathin MGO membrane also exhibits much better water permeability at 870 ± 5 L m-2 h-1 bar-1, which is 10-100 times greater than that reported for pure GO and GO-based composite membranes. Additionally, the membrane shows high rejection for salt ions (70%). Furthermore, the stability of the MGO membranes was evaluated under various conditions, and the membranes demonstrated remarkable stability for up to 60 days in a neutral environment.

A NiO-nanostructure-based electrochemical sensor functionalized with supramolecular structures for the ultra-sensitive detection of the endocrine disruptor bisphenol S in an aquatic environment.

Herein, NiO nanoparticles (NPs) functionalized with a para-hexanitrocalix[6]arene derivative (p-HNC6/NiO) were synthesized by using a facile method and applied as a selective electrochemical sensor for the determination of bisphenol S (BPS) in real samples. Moreover, the functional interactions, phase purities, surface morphologies and elemental compositions of the synthesized p-HNC6/NiO NPs were investigated via advanced analytical tools, such as Fourier-transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDX). Additionally, the synthesized p-HNC6/NiO NPs were cast on the surface of a bare glassy carbon electrode (GCE) via a drop casting method, which resulted in uniform deposition of p-HNC6/NiO/GCE over the surface of the GCE. Additionally, the developed p-HNC6/NiO/GCE sensor demonstrated an outstanding electrochemical response to BPS under optimized conditions, including a supporting electrolyte, a Briton-Robinson buffer electrolyte at pH 4, a scan rate of 110 mV s-1 and a potential window of between -0.2 and 1.0 V. The wide linear dynamic range was optimized to 0.8-70 µM to obtain a brilliant linear calibration curve for BPS. The limit of detection (LOD) and limit of quantification (LOQ) of the developed sensor were estimated to be 0.0059 and 0.019 µM, respectively, which are lower than those of reported sensors for BPS. The feasibility of the developed method was successfully assessed by analyzing the content of BPS in waste water samples, and good recoveries were achieved.

Nanodiamonds: A Cutting-Edge Approach to Enhancing Biomedical Therapies and Diagnostics in Biosensing.

Nanodiamonds (NDs) have garnered attention in the field of nanomedicine due to their unique properties. This review offers a comprehensive overview of NDs synthesis methods, properties, and their uses in biomedical applications. Various synthesis techniques, such as detonation, high-pressure, high-temperature, and chemical vapor deposition, offer distinct advantages in tailoring NDs' size, shape, and surface properties. Surface modification methods further enhance NDs' biocompatibility and enable the attachment of bioactive molecules, expanding their applicability in biological systems. NDs serve as promising nanocarriers for drug delivery, showcasing biocompatibility and the ability to encapsulate therapeutic agents for targeted delivery. Additionally, NDs demonstrate potential in cancer treatment through hyperthermic therapy and vaccine enhancement for improved immune responses. Functionalization of NDs facilitates their utilization in biosensors for sensitive biomolecule detection, aiding in precise diagnostics and rapid detection of infectious diseases. This review underscores the multifaceted role of NDs in advancing biomedical applications. By synthesizing NDs through various methods and modifying their surfaces, researchers can tailor their properties for specific biomedical needs. The ability of NDs to serve as efficient drug delivery vehicles holds promise for targeted therapy, while their applications in hyperthermic therapy and vaccine enhancement offer innovative approaches to cancer treatment and immunization. Furthermore, the integration of NDs into biosensors enhances diagnostic capabilities, enabling rapid and sensitive detection of biomolecules and infectious diseases. Overall, the diverse functionalities of NDs underscore their potential as valuable tools in nanomedicine, paving the way for advancements in healthcare and biotechnology.

Fabrication of para-dimethylamine calix[4]arene functionalized self-assembled graphene oxide composite material for effective removal of 2, 4, 6-tri-Cholorphenol from aqueous environment.

Water pollution caused by the release of organic pollutants is a major environmental concern worldwide. These pollutants can have harmful effects on aquatic ecosystems and the organisms living within them, as well as on human health when contaminated water is consumed. It is essential to implement proper treatment and management strategies to prevent and mitigate water pollution. Moreover, the major untreated industrial effluents are synthetic organic compounds especially 2,4,6-trichlorophenol (TCP) which cause several environmental issues and heath related problems in humans. To cope with this problem, an excellent 2D porous material based on p-DMAC4/GO composite has been synthesized as adsorbent material for the effective removal of 2,4,6-trichlorophenol pollutant from wastewater. In this regard, the advanced analytical tools such as Fourier-Transform infrared (FT-IR), X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and Energy-Dispersive X-ray spectroscopy (EDS) were used for its characterization. The results justified the chemical composition, excellent crystalline nature, surface morphology and elemental composition of the synthesized composite material. The synthesized adsorbent material showed 95% adsorption of TCP from wastewater system at optimal conditions i.e., pH (6), adsorbent dosage (30 mg) and shaking time (60 min). The mathematical models such as isotherms, thermodynamics and kinetics studies validate the nature of adsorption process of TCP pollutant. The adsorption data found to be best fitted with Langmuir isotherms (R2 = 0.99); whereas kinetic study suggested the pseudo-second-order nature of reaction with R2 = 0.99. The thermodynamics study confirmed the spontaneous and endothermic nature of the TCP pollutant onto the surface of p-DMAC4/GO material. Moreover, the results of current work were also compared with existing reported adsorbents and data suggested the higher efficiency, feasibility, and reusability of p-DMAC4/GO material to remove the TCP pollutant from the wastewater system.

A highly selective sensor based on p-tetranitrocalix[4]arene-capped copper nanoparticles for colorimetric and bare-eye detection of cyclophosphamide.

In the current study, one of the outstanding facile and simple protocols is proposed for the synthesis of copper nanoparticles (CuNPs) using NaBH4 as a reducing agent and p-tetranitrocalix[4]arene (p-TNC4) as a capping agent. According to our knowledge, no such technique is available in the literature for colorimetric detection of cyclophosphamide (CPA) using CuNPs at the trace level. The well-organized synthesis was confirmed via advanced spectroscopic techniques. The crystallite size, shape, phase purity, and morphological characteristics were determined via XRD, AFM, FT-IR, and UV-visible spectroscopy. At the optimal conditions for CPA detection, the sensor reveals an excellent sensitivity, selectivity, as well as stability with LOD and LOQ 20 nM and 60 nM, respectively. However, the proposed sensor showed excellent potential and selectivity for the sensing of colorimetric detection of CPA that can be effectively applied to real blood serum samples. The proposed approach is better suited as compared to reported protocols in terms of handling, simplicity, economic, energy consumption, reproducibility, and excellent performance in a very short time.

Short-acting ß2-agonist prescription patterns and clinical outcomes in Malaysia: A nationwide cohort of the SABINA III study.

Introduction: SABINA III assessed short-acting ß2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Method: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1-2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27-0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44-2.89). Conclusion: The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.

Survival Trend of Tuberculosis Patients and Risk Factors Associated with Mortality and Developing Drug-Resistant Tuberculosis in Hospital Pulau Pinang, Malaysia: A Retrospective Study.

BACKGROUND: Multidrug resistance TB (MDR-TB) has emerged as a public health issue worldwide, and the mortality rate is worrying. Therefore, this study was conducted to investigate the factors related to MDR-TB occurrence and the survival experience of TB patients. METHODS: A retrospective cohort study was conducted at Hospital Pulau Pinang in Malaysia. Medical records of active TB patients from 2014-2018 were reviewed. Cox regression was used to identify the factors associated with MDR-TB development and mortality among TB patients. RESULTS: The patients had a mean age of 48.84 ± 16.713 years, and a majority of the Chinese race (46.4%). Out of 351 TB patients, 325 (92.6%) were drug-susceptible TB, and 26 (7.4%) were diagnosed with MDR-TB. Among drug-susceptible TB patients, 245 (75.4%) achieved successful outcomes, and 73 (22.5%) passed away. In multivariable Cox regression, drug addiction, levels of white blood cells, urea, platelets, and albumin were significantly associated with death. Relapsed TB, alcohol consumption, and being single were significant risk factors for MDR-TB development. CONCLUSION: Patients achieved a success rate of 75.4%, which is encouraging but still far below the WHO target (at least an 85% success rate) and has room for further improvement.

Selective oxidation of amaranth dye in soft drinks through tin oxide decorated reduced graphene oxide nanocomposite based electrochemical sensor.

The recent studies evaluated the extensive exploitation of azo dyes as food colorant to improve the texture of food to turn the food to be very attractive. The heavy consumption of the food colorants by the food industries in commonly consumed beverages especially in the soft drinks may become the cause of certain suspected diseases. Amaranth is an azo dye which easily cleaved into amines and is suspected to be mutagen and carcinogen. Thus, the quantification of amaranth through reliable and sensitive sensor is of great importance. The SnO2/rGO nanocomposite has been engineered to be utilized as chemically modified sensor for the low-level quantification of amaranth in soft drinks and water sample. The fabricated nanocomposite materials was characterized through XRD, FTIR, raman and TEM tools which revealed average crystalline size of 23.7 nm, different surface functionalities and internal rectangle shaped morphology. The engineered nanocomposite was electrochemically characterized through electrochemical impedance spectroscopy (EIS) and Tafel plot to evaluate the electrocatalytic properties and charger transfer kinetics of SnO2/rGO/Nafion/GCE. The resistance of bare, GO/GCE and SnO2/rGO/Nafion/GCE was calculated as 812.5 Ω, 1343 Ω and 338 Ω. Certain parameters were optimized such as PBS electrolyte pH 6, scan rate 130 mV/s and potential window (0.4-1.2 V) to carry out sensitive and fluent determination process of amaranth azo dye. For the effectiveness of proposed sensor two calibration ranges were optimized from 1 to 800 nM and 1-60 µM. The LOD for both ranges were calculated as 0.68 nM and 0.0027 µM. Moreover, the anti-interference and stability profile of developed sensor were found phenomenal that suggest the exceptional electrocatalytic performance of SnO2/rGO/Nafion/GCE for amaranth.

Fabrication of sensor based on polyvinyl alcohol functionalized tungsten oxide/reduced graphene oxide nanocomposite for electrochemical monitoring of 4-aminophenol.

4-aminophenol (4-AP) is one of the major environmental pollutants which is broadly exploited as drug intermediate in the pharmaceutical formulations. The extensive release of 4-AP in the environment without treatment has become a serious issue that has led several health effects on humans. This work describe the determination of 4-AP through a new chemically modified sensor based on polyvinyl alcohol functionalized tungsten oxide/reduced graphene oxide (PVA/WO3/rGO) nanocomposite. The fabricated nanocomposite was characterized through XRD and HR-TEM to confirm the crystalline structure with average size of 35.9 nm and 2D texture with ultra-fine sheets. The electrochemical characterization of fabricated sensor was carried out by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) to ensure the charge transfer kinetics of modified sensor that revealed high conductivity of PVA/WO3/rGO/GCE. Under optimized conditions e.g. scan rate 80 mV/s, phosphate buffer (pH 6) as supporting electrolyte and potential window from -0.2 to 0.8 V, the prepared sensor showed excellent response for 4-AP. The linear dynamic range of developed method was optimized as 0.003-70 µM. The LOD of fabricated sensor based on PVA/WO3/rGO/GCE for 4-AP was calculated as 0.51 nM. The practical application of PVA/WO3/rGO/GCE was tested in real water and pharmaceutical samples. The fabricated sensor presented here, exhibited exceptional stability and sensitivity than the reported sensors and could be effectively used for the monitoring 4-AP without interferences.

Perceived risk and distress related to COVID-19 in healthcare versus non-healthcare workers of Pakistan: a cross-sectional study.

BACKGROUND: Healthcare workers (HCWs) have found themselves and their families more susceptible to contracting COVID-19. This puts them at a higher risk of psychological distress, which may compromise patient care. In this study, we aim to explore the risk perceptions and psychological distress between HCWs and non-healthcare workers (NHCWs) in Pakistan. METHODS: A cross-sectional study was conducted using an online self-administered questionnaire. Psychological distress was assessed through The Hospital Anxiety and Depression Scale (HADS). Comparisons were made between HCWs (front/backend, students/graduates) and NHCWs related to risk perceptions and stress levels related to COVID-19. Following tests for normality (Shapiro-Wilk test), variables that fulfilled the normality assumption were compared using the independent samples t-test, while for other variables Mann-Whitney U-test was employed. Pearson Chi-square test was used to compare categorical data. Multiple logistic regression techniques examined the association of participant age, gender, household income, and the presence of COVID-19 symptoms with depression and anxiety levels. RESULTS: Data from 1406 respondents (507 HCWs and 899 NHCWs) were analyzed. No significant difference was observed between HCWs and NHCWs' perception of susceptibility and severity towards COVID-19. While healthcare graduates perceived themselves (80% graduates vs 66% students, p-value 0.011) and their family (82% graduates vs 67% students, p-value 0.008) to be more susceptible to COVID-19, they were less likely to experience depression than students. Frontline HCWs involved in direct patient care perceived themselves (83% frontline vs. 70% backend, p-value 0.003) and their family (84% frontline vs. 72% backend, p-value 0.006) as more susceptible to COVID-19 than backend healthcare professionals. Over half of the respondents were anxious (54% HCWs and 55% NHCWs). Female gender, younger age, lower income, and having COVID-19 related symptoms had a significant effect on the anxiety levels of both HCWs and NHCWs. CONCLUSION: Frontline HCWs, young people, women, and individuals with lower income were at a higher risk of psychological distress due to the pandemic. Government policies should thus be directed at ensuring the mental well-being of frontline HCWs and improving their satisfaction to strengthen the health care delivery system. The findings suggest the need to provide mental health support for health workers.

Identification of heavy metal ions from aqueous environment through gold, Silver and Copper Nanoparticles: An excellent colorimetric approach.

Heavy metal pollution has become a severe threat to human health and the environment for many years. Their extensive release can severely damage the environment and promote the generation of many harmful diseases of public health concerns. These toxic heavy metals can cause many health problems such as brain damage, kidney failure, immune system disorder, muscle weakness, paralysis of the limbs, cardio complaint, nervous system. For many years, researchers focus on developing specific reliable analytical methods for the determination of heavy metal ions and preventing their acute toxicity to a significant extent. The modern researchers intended to utilize efficient and discerning materials, e.g. nanomaterials, especially the metal nanoparticles to detect heavy metal ions from different real sources rapidly. The metal nanoparticles have been broadly utilized as a sensing material for the colorimetric detection of toxic metal ions. The metal nanoparticles such as Gold (Au), Silver (Ag), and Copper (Cu) exhibited localized plasmon surface resonance (LPSR) properties which adds an outstanding contribution to the colorimetric sensing field. Though, the stability of metal nanoparticles was major issue to be exploited colorimetric sensing of heavy emtal ions, but from last decade different capping and stabilizing agents such as amino acids, vitmains, acids and ploymers were used to functionalize the metal surface of metal nanoparticles. These capping agents prevent the agglomeration of nanoparticles and make them more active for prolong period of time. This review covers a comprehensive work carried out for colorimetric detection of heavy metals based on metal nanoparticles from the year 2014 to onwards.

Changing Perceptions of Rural Frontline Workers and Caregivers About Management of Childhood Diarrhea and Pneumonia Despite Several Inequities: The Nigraan Plus Trial in Pakistan.

PURPOSE: Diarrhea and pneumonia greatly contribute to high childhood mortality in Pakistan. Frontline community health workers or the Lady Health Workers (LHWs) provide care at the doorstep of over 60% of Pakistan's rural residents. Difficult terrain, lack of supplies, and inadequate supervision put these LHWs at an added disadvantage in the timely diagnosis and delivery of known treatment options to community caregivers (CCGs). This study aims to assess whether a supportive supervision intervention through Lady Health Supervisors (LHSs) using enhanced mentorship and written feedback cards have the potential to improve case management of childhood diarrhea and pneumonia. STUDY SETTING AND DESIGN: This perception-based qualitative inquiry nested within the Nigraan Plus trial included LHSs, LHWs, and CCGs as the participants. Twenty-two in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were conducted before a supportive supervision intervention in 2017, and 10 FGDs were conducted in 2019 once the intervention concluded. Data were analyzed using manual content analysis. RESULTS: The perceived ability of LHWs and LHSs to describe the danger signs of diarrhea and pneumonia, classify dehydration and relate respiratory rate to the severity of pneumonia improved over time. Appropriate prescription of zinc in diarrhea and antibiotics in pneumonia was noted. Furthermore, CCGs' trust in LHWs increased following the intervention, and they reported a growing inclination to contact LHWs as their first point of care. LHWs in the intervention arm were more satisfied with their job due to frequent supervisory visits and continuous feedback by LHSs. CONCLUSION: Despite geographic, social, and economic inequities, supportive supervision has the potential to improve knowledge, practice, and skills of frontline health workers related to CCM of childhood diarrhea and pneumonia in disadvantaged rural communities. Additionally, the trust of CCGs in the health workers' ability to manage such cases is also enhanced.

Gender-specific psychological and social impact of COVID-19 in Pakistan.

BACKGROUND: COVID-19 has rapidly spread across the world. Women may be especially vulnerable to depression and anxiety as a result of the pandemic. AIMS: This study attempted to assess how gender affects risk perceptions, anxiety levels and behavioural responses to the COVID-19 pandemic in Pakistan, to recommend gender-responsive health policies. METHODS: A cross-sectional online survey was conducted. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale, and questions on their risk perceptions, preventive behaviour and information exposure. Multiple logistic regression analysis was used to assess the effects of factors such as age, gender and household income on anxiety levels. RESULTS: Of the 1391 respondents, 478 were women and 913 were men. Women considered their chances of survival to be relatively lower than men (59% v. 73%). They were also more anxious (62% v. 50%) and more likely to adopt precautionary behaviour, such as avoiding going to the hospital (78% v. 71%), not going to work (72% v. 57%) and using disinfectants (93% v. 86%). Men were more likely to trust friends, family and social media as reliable sources of COVID-19 information, whereas women were more likely to trust doctors. CONCLUSIONS: Women experience a disproportionate burden of the psychological and social impact of the pandemic compared with men. Involving doctors in healthcare communication targeting women might prove effective. Social media and radio programmes may be effective in disseminating COVID-19-related information to men.

Hydrothermal synthesis of hydroxyapatite-reduced graphene oxide (1D-2D) hybrids with enhanced selective adsorption properties for methyl orange and hexavalent chromium from aqueous solutions.

The presence of organic dye molecules and heavy metal ions in water causes ecological and public health problems. Therefore, remediation of water/wastewater contaminated with organic dye molecules and toxic metal ions is of importance. Herein, a reduced graphene oxide (RGO)-hydroxyapatite (Hat) (1D-2D) hybrid composite was fabricated through a hydrothermal process and applied for the adsorption of methyl orange (MO) and hexavalent chromium (Cr(VI)) from water. The as-fabricated RGO-Hat hybrids were characterized using FTIR, XRD, HR-TEM, SEM, XPS, EDAX, and TGA-DSC analytical techniques. The influencing parameters of adsorption performance, namely solution pH, contact time, and co-interfering ions, were explored to obtain the maximum adsorption capacity of contaminants from the solid-liquid interface. Batch studies revealed that MO and Cr(VI) adsorption followed the pseudo-second-order kinetic and the Langmuir isotherm models. The adsorption capacity was 49.14 and 45.24 mg g-1 for MO and Cr(VI), respectively. The adsorption of such ions over RGO-Hat hybrids was mainly driven by several uptake mechanisms viz, electrostatic force of attraction, π-π interactions, and hydrogen bonding. Thus, this study demonstrated that the RGO-Hat hybrid is a potential candidate for the treatment of MO and Cr(VI) from water.

Tracheobronchopathia osteochondroplastica-stalactite of airways.

A case of tracheobronchopathia osteochondroplastica (TO) was diagnosed in a 53-year-old man, who presented with prolonged cough and recurrent respiratory tract infection. Bronchoscopy revealed exostosis over the anterolateral wall of trachea and main bronchi sparing the posterior membranous wall. The endobronchial biopsy subsequently revealed ossification of the cartilage. To date, the aetiology of this condition remains unknown, and treatment is mainly symptomatic, emphasizing on timely management of recurrent respiratory infections. Bronchoscopy or surgical intervention is usually reserved for symptomatic patients with severe airway narrowing and airflow obstruction.

Efficacy, Safety and Immunogenicity of MB02 (Bevacizumab Biosimilar) versus Reference Bevacizumab in Advanced Non-Small Cell Lung Cancer: A Randomized, Double-Blind, Phase III Study (STELLA).

BACKGROUND: MB02 (bevacizumab biosimilar) showed similar structural, functional, and pharmacokinetic properties to reference bevacizumab (Avastin®; EU-bevacizumab). OBJECTIVES: To confirm clinical similarity between MB02 and EU-bevacizumab, a comparability study was undertaken in the first-line treatment of stage IIIB/IV non-squamous non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: This multinational, double-blind, randomized, phase III study (STELLA) compared MB02 or EU-bevacizumab (15 mg/kg) administered with chemotherapy (paclitaxel 200 mg/m2 and carboplatin AUC6) on Day 1 of every 3-week cycle for 6 cycles (Week 18), followed by MB02/EU-bevacizumab in blinded monotherapy until disease progression, unacceptable toxicity, death, withdrawal of consent or end of study (Week 52). The primary efficacy endpoint was objective response rate (ORR) evaluated by an independent radiological review committee (IRC) at Week 18 (intent-to-treat population). Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety and immunogenicity. RESULTS: A total of 627 subjects were randomized 1:1 to MB02 (n = 315) or EU-bevacizumab (n = 312). ORR, assessed by the IRC at Week 18, was comparable in MB02 (40.3%) and EU-bevacizumab (44.6%) groups. ORR risk ratio of 0.910 (90% CI 0.780 to 1.060; 95% CI 0.758 to 1.092) and ORR risk difference of -4.02 (90% CI -10.51 to 2.47; 95% CI -11.76 to 3.71) were within the similarity predefined margins. There were no significant differences between MB02 and EU-bevacizumab groups in median PFS (36.0 vs 37.3 weeks, respectively; HR 1.187; 95% CI 0.98 to 1.44) and median OS (not achieved; HR 1.108; 95% CI: 0.83 to 1.49) at the end of study. The safety profile of MB02 and EU-bevacizumab regarding nature, frequency and severity of the adverse events (AE) was comparable. The most frequent grade ≥3 investigational-product-related AEs were hypertension and anemia, with a difference between treatment groups of <5%. Anti-drug antibodies (ADA) and neutralizing ADA (NAb) incidence were similar in both treatment groups. CONCLUSION: MB02 demonstrated similar efficacy to EU-bevacizumab, in combination with carboplatin and paclitaxel, in subjects with advanced non-squamous NSCLC, with comparable safety and immunogenicity profiles. CLINICAL TRIAL REGISTRATION: EudraCT No. 2017-001769-26; ClinicalTrials.gov: NCT03296163.

Translation and validation of the Test of Adherence to Inhalers (TAI) questionnaire among adult patients with asthma in Malaysia.

OBJECTIVE: The Test of Adherence to Inhalers (TAI) is a validated self-reported questionnaire that can reliably assess adherence to inhalers through patient self-report. However, it was not available in Bahasa Melayu (BM) language, nor has it been validated for use in the Malaysian population. The study aimed, therefore, to translate the 10-item TAI questionnaire into BM and evaluate its psychometric properties. METHODS: The translation of the English version of the valid 10-item TAI questionnaire into BM was followed by subjecting it to a series of tests establishing factorial, concurrent and known group validities. Concurrent validity was assessed through Spearman's rank correlation coefficient against pharmacy refill-based adherence scores. Known group validity was assessed by cross-tabulation against asthma symptom control and using chi-square test. The internal consistency of the test scale was determined by a test-retest method using Cronbach's alpha (α) value and intraclass correlation coefficients. RESULTS: A total of 120 adult asthma patients participated in the study. A 2-factor structure was obtained and confirmed with acceptable fit indices; CFI, NFI, IFI, TLI >0.9 and, RMSEA was 0.08. The reliability of the scale was 0.871. The test-retest reliability coefficient for the total sum score was 0.832 (p < 0.01), which indicated good reliability. The 10-item TAI-BM established concurrent and known group validities. The sensitivity and specificity of the tool were >85%. CONCLUSIONS: The scale successfully translated into BM and validated. The 10-item TAI-BM appears fit for use in testing inhaler adherence of Malaysian patients with asthma.

Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital.

INTRODUCTION: Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally. OBJECTIVES: This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes. METHODS: We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest. RESULTS: The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07). CONCLUSIONS: One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Effectiveness of Home Visits in Adult Patients with Asthma: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: The effectiveness of home visits is well discussed for children with asthma, but limited in adults. OBJECTIVE: The present systematic review aimed to investigate the potential role of home visits in improving outcomes among adult patients with asthma. METHODS: The systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An extensive literature search was conducted using databases such as PubMed, ProQuest, CINAHL, The Cochrane Library, PsycINFO, and Google Scholar from inception to June 2019. The studies included were randomized controlled trials, which reported asthma outcomes in adult patients. RESULTS: The literature search yielded 8331 publications, of which 63 studies were selected for full-text review, and of these studies, 9 studies with a total of 2011 patients were included in the final analysis. The included randomized controlled trials reported quality of life, asthma symptoms, exacerbations, health care utilization, and pulmonary function. Improvements in asthma outcomes were observed predominantly in quality of life. The effects on asthma symptom control were inconsistent. The evidence on the impact of home visits in asthma exacerbations and health care utilization was rather limited. There were no significant differences observed between intervention versus control arms in terms of pulmonary function; however, 1 study reported significant improvements in peak expiratory flow rate. CONCLUSIONS: Home visits may serve as an adjuvant activity that complements the existing health care system-based initiatives. It may be concluded that home visits have the potential to improve outcomes in adult patients with asthma; however, the randomized controlled trials reviewed in the present systematic review reported several limitations that warrant further investigation.

Adsorptive performance of lanthanum encapsulated biopolymer chitosan-kaolin clay hybrid composite for the recovery of nitrate and phosphate from water.

Nitrate and phosphate are primary pollutants of water/wastewaters for eutrophication and methemoglobinemia diseases, harshly threatening the security of aquatic environments and human health as well as all living beings. The present work investigates the adsorption performance and mechanism of lanthanum encapsulated chitosan-kaolin clay (LCK) hybrid composite was prepared and utilized for the remediation of nitrate and phosphate from water. The fabricated LCK hybrid composite was characterized using XRD, SEM, BET, EDAX, TGA-DTA and FTIR analysis. The removal of nitrate and phosphate onto the LCK composite defined by pseudo-second-order kinetic model whereas the isotherms are described by Freundlich adsorption isotherm model and thermodynamic experiments showed spontaneous and exothermic nature of the adsorption process. Results also demonstrated that the LCK hybrid composite exhibited extremely high nitrate and phosphate adsorption capacity and stability which followed the mechanisms by ion exchange, complexation and electrostatic interactions. Adsorption-desorption experiments revealed that the LCK hybrid composite could be potentially reused with maintaining high adsorption efficiency. This study highlights the novel low-cost, eco-friendly and promising adsorbent for efficient denitrification and dephosphorization from water/ wastewater.