Prof. Dr. Azizah Hanom Ahmad

BackgroundBoth anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy.MethodsPatients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018–December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set.ResultsThis study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL …

BackgroundSodium–glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.MethodsEMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and …

BackgroundPaediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children (MIS-C) emerged in April, 2020. The paediatric comparisons within the RECOVERY trial aimed to assess the effect of intravenous immunoglobulin or corticosteroids compared with usual care on duration of hospital stay for children with PIMS-TS and to compare tocilizumab (anti-IL-6 receptor monoclonal antibody) or anakinra (anti-IL-1 receptor antagonist) with usual care for those with inflammation refractory to initial treatment.MethodsWe did this randomised, controlled, open-label, platform trial in 51 hospitals in the UK. Eligible patients were younger than 18 years and had been admitted to hospital for PIMS-TS. In the first randomisation, patients were randomly assigned (1: 1: 1) to usual care (no additional treatments), usual care plus …

Semi-visible jets, with a significant contribution to the event's missing transverse momentum, can arise in strongly interacting dark sectors. This results in an event topology where one of the jets can be aligned with the direction of the missing transverse momentum. The first search for semi-visible jets produced via a t-channel mediator exchange is presented. The analysis uses proton-proton collisions with an integrated luminosity of 139 fb−1 and a centre-of-mass energy of 13 TeV, collected with the ATLAS detector during the Run 2 of the LHC. No excess over Standard Model predictions is observed. Assuming a coupling strength of unity between the mediator, a Standard Model quark and a dark quark, mediator masses up to 2.7 TeV are excluded at the 95% confidence level. Upper limits on the coupling strength are also derived.

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the …

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was …

BackgroundThe EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.MethodsEMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease …

Introduction Pharmacy teams, particularly in community pharmacy, are beginning to be recognised as important contributors to mental health support and suicide prevention efforts. The need for appropriate referral and triage routes from pharmacy to other health and social care providers has been highlighted. (1) Support resources for mental health might provide a route for triage, including to third sector organisations. This will become increasingly important as antidepressants are included in the New Medicines Service (NMS). (2) Aim To explore the mental health support resources that pharmacists and pharmacy students are aware of; and identify if, and how, they use these resources in a professional or personal capacity. Methods Pharmacists and pharmacy students were invited to complete an anonymous, online questionnaire hosted via Qualtrics™ …

Cross-section measurements for a Z boson produced in association with high-transverse-momentum jets (p T≥ 100 GeV) and decaying into a charged-lepton pair (e+ e−, μ+ μ−) are presented. The measurements are performed using proton–proton collisions at= 13 TeV corresponding to an integrated luminosity of 139 fb− 1 collected by the ATLAS experiment at the LHC. Measurements of angular correlations between the Z boson and the closest jet are performed in events with at least one jet with p T≥ 500 GeV. Event topologies of particular interest are the collinear emission of a Z boson in dijet events and a boosted Z boson recoiling against a jet. Fiducial cross sections are compared with state-of-the-art theoretical predictions. The data are found to agree with next-to-next-to-leading-order predictions by NNLO jet and with the next-to-leading-order multi-leg generators M ad G raph 5_ a MC@ NLO and S herpa.

In recent year, the development of the electronic devices is rapidly growing and that was used in entire world but electronic devices generate the electromagnetic wave (EM) radiation. That radiation can affect the people’s health and interference normal operation of other electronic devices. Hence the researchers have conducted studies in the field of microwave absorption to reduce the risk of electromagnetic (EM) radiation. Microwave absorber comes with many form and material to enhance the absorption performance. This study aims to improve absorption performance of pyramidal geopolymer microwave absorber by using slotted design. The slotted design used on pyramidal geopolymer microwave absorber is triangular shape and that shape was isosceles triangle type. The hollow pyramidal was coated with a geopolymer absorbing material to form hollow pyramidal microwave absorber. Geopolymers are …

IntroductionAntimicrobial prophylaxis is critical in mitigating opportunistic infections in patients who have undergone bone marrow transplantation. Trimethoprim-sulfamethoxazole is the standard of care antibiotic for prophylaxis of pneumocystis jiroveci pneumonia (PJP). We hypothesized that patients with reported sulfonamide allergy would be more likely to receive an alternative antibiotic for PJP prophylaxis and have increased risk of opportunistic infections.MethodsData were obtained using TriNetX, a de-identified health research network for population cohort research. Bone marrow transplant patients with a reported sulfonamide allergy were compared to those without the allergy. We evaluated the following outcomes based on ICD-10 code: diagnosis of pneumocystis jiroveci pneumonia (PJP), pneumonia of other causes, neutropenic fever, bacteremia and sepsis. We explored the outcome up to 12 months …

This research aims to measure, assess, and evaluate the impact of the Malaysia ICT Volunteers (MIV) Programme, which will provide a holistic understanding of the effectiveness of the MIV programme (including MIV roles and gap areas) and provide suggestions on effective ways to engage, ensure knowledge transfer and inculcate pos1t1ve elements in the community. As part of this investigation, guided by the theory of planned behaviour (TPB), an online survey was employed, to elicit the views of MIV volunteers and community members who have employed benefitted from the MIV initiatives. Two (2) questionnaires were developed for this purpose, and their face and content validity were assessed through focus group discussions with experts from MCMC. During the data collection period from August to October 2021, 329 valid cases from the MIV volunteers and 250 valid cases from the MIV community were gathered. Structural Equation Modelling (SEM) was used to determine the effectiveness of the MIV programme in terms of its impact on the community members' digital literacy and MIV volunteers' willingness to contribute to MIV initiatives. Statistical results confirmed that Attitude towards MIV and Perceived Behavioural Control exert significant influence on Intention to Volunteer, which in turn significantly influences the ICT Volunteering Behaviour of MIV volunteers. The findings related to the MIV community similarly reveal that their Attitude towards MIV and Perceived Behavioural Control have a significant impact on MIV Awareness (AW), which exerts a significant influence on their Digital Literacy Behaviour. On the other hand, Subjective …

This article reports the laser calibration of the hadronic Tile Calorimeter of the ATLAS experiment in the LHC Run 2 data campaign. The upgraded Laser II calibration system is described. The system was commissioned during the first LHC Long Shutdown, exhibiting a stability better than 0.8% for the laser light monitoring. The methods employed to derive the detector calibration factors with data from the laser calibration runs are also detailed. These allowed to correct for the response fluctuations of the 9852 photomultiplier tubes of the Tile Calorimeter with a total uncertainty of 0.5% plus a luminosity-dependent sub-dominant term. Finally, we report the regular monitoring and performance studies using laser events in both standalone runs and during proton collisions. These studies include channel timing and quality inspection, and photomultiplier linearity and response dependence on anode current.

Protecting natural forests such as those identified as high conservation value (HCV) areas may facilitate crop production due to the benefit from ecosystem services provided by biodiversity spill-over from adjacent forests. To investigate the effect of protecting contiguous and isolated forests adjacent to oil palm plantations on crop health, we measured the distance between oil palm plots and the continuous forest and forest patch boundaries. We surveyed 715 oil palm sample plots comprising 613 plots in large-scale oil palm plantation and 102 plots in smallholdings that were at least 300 m apart and had a radius of 100 m. Satellite imagery and ancillary spatial data from 2016, 2018, 2019 and 2020 of Negeri Sembilan, Malaysia were used to determine elevation and vegetation indices (VIs). The VIs derived were the Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI), and Normalized …

With the HL-LHC upgrade of the LHC machine, an increase of the instantaneous luminosity by a factor of five is expected and the current detection systems need to be validated for such working conditions to ensure stable data taking. At the CERN Gamma Irradiation Facility (GIF++) many muon detectors undergo such studies, but the high gamma background can pose a challenge to the muon trigger system which is exposed to many fake hits from the gamma background. A tracking system using RPCs is implemented to clean the fake hits, taking profit of the high muon efficiency of these chambers. This work will present the tracking system configuration, used detector analysis algorithm and results.

MethodsThis retrospective study was done on 27 biopsy proven stage III NSCLC patients-22 Adenocarcinoma (AC) and 5 Squamous cell carcinoma (SCC), from January 2019 to January 2022 after reviewing records of 68 patients on the basis of pre and post treatment FDG PET scan availability. 12 patients with AC received NACT (Pemetrexed+ carboplatin for 4-6 cycles) followed by Concurrent Chemoradiotherapy (CCRT) with RT dose of 60 Gy in 30 fractions at 2 Gy per fraction for 5 days in a week with concurrent weekly chemotherapy either paclitaxel+ Carboplatin or Cisplatin for 5-6 cycles. 10 patients with AC received only NACT (Pemetrexed+ carboplatin for 4 cycles). 5 Patients with SCC received only NACT (Gemcitabine+ Cisplatin for 3-6 cycles). FDG PET scan was done between 1 to 3 week prior to start of the treatment and 3 weeks after the completion of treatment. Pre and post treatment tumor dimension …

The three educational officers of Unit Pemulihan Khas in Pejabat Pendidikan Daerah Cameron Highlands (PPDCH) realized their unsystematic remedial data management. At the time when this case is written (September 2020) the process of gathering remedial data is still done using the MS Excel template, which may subject to some errors. In addition, the procedure makes the officers difficult to manage the data, especially to produce customized reports. Hence, they believe that there is an urgent need to develop a computerized system that can handle all the processes of remedial data management, starting from data collection until report preparation. Therefore, this case study has investigated the issue in detail and proposed an online Remedial Data Management System. In January 2021, a prototype of the has been developed. However, this prototype was subjected to several drawbacks, especially in terms of system design. Therefore, this case is suitable to be used in the subject of System Analysis and Design.

The muon system of the CERN Compact Muon Solenoid (CMS) experiment includes more than a thousand Resistive Plate Chambers (RPC). They are gaseous detectors operated in the hostile environment of the CMS underground cavern on the Large Hadron Collider where pp luminosities of up to are routinely achieved. The CMS RPC system performance is constantly monitored and the detector is regularly maintained to ensure stable operation. The main monitorable characteristics are dark current, efficiency for muon detection, noise rate etc. Herein we describe an automated tool for CMS RPC current monitoring which uses Machine Learning techniques. We further elaborate on the dedicated generalized linear model proposed already and add autoencoder models for self-consistent predictions as well as hybrid models to allow for RPC current predictions in a distant future.

BackgroundLow-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group.MethodsThis randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation< 92% on room air) were randomly allocated (1: 1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone …

This study aimed to determine the impact of multimodal therapy on adrenalectomy for localized adrenocortical carcinoma (ACC) and the overall survival of patients. The study included 200 patients. A retrospective analysis was conducted on 200 patients diagnosed with localized ACC who underwent adrenalectomy at a medical center. The patients were divided into the multimodal therapy group (n= 100) and the adrenalectomy alone group (n= 100). Patient characteristics, treatment modalities, pathological findings, and follow-up data were analyzed. The primary outcome measures included recurrence rates, overall survival rates, and treatment-related complications. The 5-year overall survival rate was significantly higher in Group B (68%) compared to Group A (45%)(p< 0.001). Group B also had a higher 5-year disease-free survival rate (54%) compared to Group A (32%)(p= 0.023). The local recurrence rate was lower in Group B (18%) compared to Group A (32%). Treatment-related adverse events occurred slightly more frequently in Group B (22%) than in Group A (15%) but did not significantly impact patient outcomes. Subgroup analyses consistently showed improved overall survival in Group B across different age groups, tumor stages, and histology. Adding multimodal therapy to adrenalectomy for localized ACC significantly improved overall survival, disease-free survival, and reduced local recurrence rates. Multimodal therapy should be considered a potential treatment approach for improving outcomes in ACC patients. Further studies with larger cohorts and prospective designs are needed to confirm these findings and optimize treatment …