ABSTRACT
@#Introduction: Chronic exposure to aflatoxin can lead to complications such as liver failure and cancer. There are many factors that affect aflatoxin occurrence. This study aimed to assess the association between sociodemographic factors and the knowledge, attitude and practice towards aflatoxin with urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia. Methods: This was a cross-sectional study conducted among healthy Malaysian adults aged 18 to 60 years residing in Hulu Langat district, Malaysia. Socio-demographic background and the knowledge, attitude and practice of respondents towards aflatoxin were assessed through questionnaires. Non-fasting urine sample (15 ml) was collected in the morning and urinary aflatoxin M1 level was quantified. Results: Of the 444 healthy Malaysian adults, 199 urine samples were detected with aflatoxin M1. From 37 positive samples with aflatoxin M1 level above detection limit (0.64 ng/ml), mean value was 1.23±0.91 ng/ml (range = 0.65-5.34 ng/ml). Urinary aflatoxin M1 occurrence was significantly different across ethnicity, age group, monthly household income, attitude and practice towards aflatoxin. Binomial logistic regression confirmed ethnicity and monthly household income as factors contributing to urinary aflatoxin M1 occurrence. Chinese were 3.20 times more likely to have aflatoxin exposure than non-Chinese. Detected urinary aflatoxin M1 was more common among household with a monthly income above RM1,500. Conclusion: The results provided an insight to explain the variation in aflatoxin occurrence among the population.
ABSTRACT
As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.