International Islamic University Malaysia

In this work, we have demonstrated the generation of multi- and dual-wavelength fiber lasers at the S-band using an all-fiber-based Lyot filter in a thulium-doped fluoride fiber laser. The Lyot filtering mechanism was first realized at S-band using a polarizer, two polarization controllers, and a 20 m polarization-maintaining fiber. About 13 lasing lines were observed at the S-band covering the wavelength region of 1502 to 1505 nm. The highest possible optical signal-to-noise ratio in a multiwavelength fiber laser was 57.2 dB at the operating wavelength of 1504.52 nm. The stability of this multiwavelength fiber laser was also realized for 2 hours. A highly stable multiwavelength with very slight power fluctuation at lasing peaks of only about ≤0.4 dB: there are no wavelength changes during the multiwavelength laser operation for 2 hours. The free spectral range (FSR) of the all-fiber Lyot filter was 0.24 nm, and the frequency bandwidth was achieved as 31.78 GHz. When a tunable bandpass filter (TBPF) was included in the laser cavity, a dual-wavelength fiber laser (DWFL) was also realized at 1504.98 and 1505.22 nm.

Biomaterials are materials that have been formed from or created by biological organisms such as plants, animals, bacteria, fungus, and other forms of life are referred to as biologically derived materials. Biomaterials are normally designed to interface with biological systems, for the treatment, augmentation, or replacement of biological functions. Across billions of years, life has been composed of and existed within these biomaterial molecules, monomers, and polymers. For instance, biomaterials of polysaccharides are sugars or starch polymers. Cellulose is the most ubiquitous and abundant polysaccharide. Polysaccharides are found in the tissues of both trees and humans. Meanwhile, natural biomaterials are substances that are derived from natural sources such as plants, animals, or minerals, and are used in medical and healthcare applications. Examples of natural biomaterials include collagen, chitosan, silk, cellulose, hyaluronic acid, and bone minerals such as hydroxyapatite. These materials are attractive in the field of regenerative medicine and tissue engineering due to their biocompatibility and biodegradability. Additionally, some natural biomaterials can mimic the physical and chemical properties of the body's natural tissues, making them ideal for use in implants and scaffolds. Recent advances in the production of natural biomaterials include the development of more efficient and scalable manufacturing processes, which has made them more widely available and accessible for use in medical applications. In addition, advances in the understanding of the biological interactions between these materials and the body have allowed for the development of new and improved medical devices and therapies. The use of natural biomaterials also provides unique opportunities for customization and personalization in medical treatment. For example, natural biomaterials such as collagen and hyaluronic acid can be engineered to meet specific patient needs, such as tissue repair and regeneration, wound healing, and drug delivery. Overall, natural biomaterials have shown great promise in many fields. This chapter's goal is to give readers a quick introduction to naturally derived biomaterials and their advances and opportunities. For example, recent developments in the production of natural biomaterials have made them more widely available and accessible for use in medical applications, and advances in the understanding of the biological interactions between these materials and the body have allowed for the development of new and improved medical devices and therapies. In the coming years, the adoption of new advanced experimental methodologies, such as bioengineering approaches, will alter the practice of medicine in the applications using natural derived biomaterials. Tissue engineering, a multidisciplinary field of research involving the principles of materials science, engineering, biological sciences, and medical research, is a clear illustration of this.

Background Southeast Asia has a high prevalence of metallo-β-lactamase-producing carbapenem-resistant Enterobacterales (CRE). Ceftazidime-avibactam (CZA) and Aztreonam (ATM) combination is one of the preferred therapeutic options against them. Methods A prospective study was performed at a university hospital in Kuala Lumpur, Malaysia, involving CRE isolates resistant to CZA and ATM. Susceptibility testing results were interpreted using the Clinical and Laboratory Standards Institute (CLSI) breakpoints. A synergy test for both agents [as in Falcone et al. study (CID 2021:72)] was carried out using the double disk synergy (DDS) and the gradient test superposition (GTS) methods. Synergy was considered present when the inhibition zone between the two disks became evident and if CZA reduced the ATM minimum inhibitory concentration (MIC) below its CLSI susceptibility cut-off (≤4 mg/L). Results Eleven isolates (8 K. pneumoniae, 2 E. coli, and 1 K. aerogenes) from 10 patients were tested. Concordant results were seen for both methods for all the isolates. Synergy was demonstrated with 8 isolates; for 2 of the 3 isolates with no synergy, the MIC of ATM reduced to an intermediate result after GTS. The most common sites of infection were bloodstream infection (4) and intra-abdominal infection (3). Five patients received the CZA-ATM combination (one received two courses of CZA-ATM). Five isolates from four patients demonstrated synergy, and one showed intermediate synergy. The latter received additional IV tigecycline. The median time to CZA-ATM initiation from the index culture was 8 (3-13) days. The median duration of therapy was 21 (6-28) days. Four patients responded favorably to the agents (survived the infection), while the remaining patient died. For those that did not receive CZA-ATM, one received polymyxin-based therapy, one received high-dose, extended-infusion meropenem, and one received no treatment. Only the patient that received meropenem survived the infection. Please refer to Table 1.0 for more detail. Conclusion Based on this small sample size, only a 73% synergy rate between CZA and ATM was seen for our CRE isolates resistant to CZA and ATM. Favorable treatment response was seen in those receiving the CZA-ATM combination therapy when synergy was demonstrated Disclosures All Authors: No reported disclosures

Breast cancer is the most frequent kind of cancer and the second leading cause of mortality worldwide, behind heart disease. Next-generation sequencing technologies enables for unprecedented enumeration of human resident gut microorganisms, conferring novel insights into the role of the microbiota in health and individuals with breast cancer. A growing body of research on microbial dysbiosis seems to indicate an elevated risk of health complications including cancer. Although several dysbiosis indices have been proposed, their underlying methodology, as well as the cohorts and conditions of breast cancer patients are significantly different. To date, these indices have not yet been thoroughly reviewed especially when it comes to researching the estrogen-gut microbiota axis. Instead of providing a thorough rating of the most effective diversity measurements, the current work aims to be used to assess the relevance of each study’s findings across the demographic data, different subtypes, and stages of breast cancer, and tie them to the estrobolome, which controls the amount of oestrogen that circulates through humans. This review will cover 11 studies which will go into a detailed discussion for the microbiome results of the mentioned studies, leaving to the user the final choice of the most suited indices as well as highlight the observed bacteria found to be related to the estrobolome in hopes of giving the reader a better understanding for the biological cross-talk between gut microbiome and breast cancer progression.

This study aimed to compare the 3D skull models reconstructed from computed tomography (CT) images using three different open-source software with a commercial software as a reference. The commercial Mimics v17.0 software was used to reconstruct the 3D skull models from 58 subjects. Next, two open-source software, MITK Workbench 2016.11, 3D Slicer 4.8.1 and InVesalius 3.1 were used to reconstruct the 3D skull models from the same subjects. All four software went through similar steps in 3D reconstruction process. The 3D skull models from the commercial and open-source software were exported in standard tessellation language (STL) format into CloudCompare v2.8 software and superimposed for geometric analyses. Hausdorff distance (HD) analysis demonstrated the average points distance of Mimics versus MITK was 0.25 mm. Meanwhile, for Mimics versus 3D Slicer and Mimics versus InVesalius, there was almost no differences between the two superimposed 3D skull models with average points distance of 0.01 mm. Based on Dice similarity coefficient (DSC) analysis, the similarity between Mimics versus MITK, Mimics versus 3D Slicer and Mimics versus InVesalius were 94.1, 98.8 and 98.3%, respectively. In conclusion, this study confirmed that the alternative open-source software, MITK, 3D Slicer and InVesalius gave comparable results in 3D reconstruction of skull models compared to the commercial gold standard Mimics software. This open-source software could possibly be used for pre-operative planning in cranio-maxillofacial cases and for patient management in the hospitals or institutions with limited budget.

This comprehensive paper conducts an in-depth review of personal exposure and air pollutant levels within the microenvironments of Asian city transportation. Our methodology involved a systematic analysis of an extensive body of literature from diverse sources, encompassing a substantial quantity of studies conducted across multiple Asian cities. The investigation scrutinizes exposure to various pollutants, including particulate matters (PM10, PM2.5, and PM1), carbon dioxide (CO2), formaldehyde (CH2O), and total volatile organic compounds (TVOC), during transportation modes such as car travel, bus commuting, walking, and train rides. Notably, our review reveals a predominant focus on PM2.5, followed by PM10, PM1, CO2, and TVOC, with limited attention given to CH2O exposure. Across the spectrum of Asian cities and transportation modes, exposure concentrations exhibited considerable variability, a phenomenon attributed to a multitude of factors. Primary sources of exposure encompass motor vehicle emissions, traffic dynamics, road dust, and open bus doors. Furthermore, our findings illuminate the influence of external environments, particularly in proximity to train stations, on pollutant levels inside trains. Crucial factors affecting exposure encompass ventilation conditions, travel-specific variables, seat locations, vehicle types, and meteorological influences. The culmination of this rigorous review underscores the need for standardized measurements, enhanced ventilation systems, air filtration mechanisms, the adoption of clean energy sources, and comprehensive public education initiatives aimed at reducing pollutant exposure within city transportation microenvironments. Importantly, our study contributes to the growing body of knowledge surrounding this subject, offering valuable insights for policymakers and researchers dedicated to advancing air quality standards and safeguarding public health.

Introduction Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues. Study design A cross-sectional study, conducted across Punjab, Pakistan. Method The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists. Results 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents ‘never’ or ‘sometimes’ made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, ‘opioid overdose management’, ‘opioid use monitoring’ and ‘therapeutic uses of opioids’. Conclusion Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.

This paper demonstrated a Q-switched erbium-doped fiber laser (EDFL) using an organic saturable absorber (SA) based on 8-HQCdCl2H2O material. The organic thin film was prepared using the casting process. The proposed Q-switched EDFL has a maximum repetition rate of 143 kHz, minimum pulse duration of 1.85 µs and the highest pulse energy of 167 nJ. The Q-switched peak laser was at a central wavelength of 1 531 nm with a 3 dB bandwidth of 3.52 nm and power intensity of 2.64 dBm.

Background Turner Syndrome (TS) is a rare sex chromosome abnormality occurring in 1 in 2500 female live births. To date, there is limited data on TS patients in Malaysia. This study aimed to investigate the quality of life (QoL) and body image disturbances among adult population with TS in comparison to age-matched controls in a tertiary hospital in Kuala Lumpur: Hospital Chancellor Tuanku Mukhriz, Universiti Kebangsaan Malaysia (HCTM, UKM). Methods This was a cross-sectional study carried out in HCTM, UKM, Kuala Lumpur. TS participants who attended clinic in HCTM, UKM and controls who were hospital staff members were recruited via purposive sampling. TS participants’ sociodemographic and clinical profiles were retrieved from medical records. Two validated, translated questionnaires; World Health Organization Quality of Life (WHOQOL-BREF) questionnaire and Body Image Disturbances Questionnaires (BIDQ) were completed by participants. Results A total of 34 TS patients were approached and 24 (70.5%) of them participated in this study. Their median (IQR) age was 24.0 (7.0) years and their responses were compared to 60 age-matched healthy females as controls [median age (IQR) = 24.0 (8.0) years]. The most common medical problem in TS participants was premature ovarian insufficiency (n = 23; 95.8%). There were no significant differences between TS and control groups’ median scores (overall QOL; 4.00 vs. 4.00, general health; 3.50 vs. 4.00, physical health; 14.86 vs. 15.43, psychological health; 14.67 vs. 14.00 and environment; 15.00 vs. 15.50) of the different WHOQOL-BREF domains. However, TS participants were found to score 13.33 against 16.00, lower than the control group (p < 0.05) in the social relationship domain. Comparatively, body image concerns among TS respondents were significantly higher in impairment in the mainly social areas of functioning (p < 0.05). Conclusion The study demonstrated that the overall QoL of TS participants was good and almost similar to that of the controls. However, TS group had significantly lower scores for social domain and had greater concerns in social interactions, thus affecting their social life.

Enzymatic browning is of concern as it can affect food safety and quality. In this study, an effective and safe tyrosinase inhibitor and anti-browning agent, methyl 4-pyridyl ketone thiosemicarbazone (4-PT), was synthesised and characterised using Fourier-transform infrared (FTIR) spectroscopy, CHNS elemental analysis, and proton (1H) and carbon-13 (13C) nuclear magnetic resonance (NMR) spectroscopy. The vibrational frequencies of 4-PT were studied theoretically using vibrational energy distribution analysis (VEDA). Density functional theory (DFT) was applied to elucidate its chemical properties, including the Mulliken atomic charges, molecular electrostatic potential (MEP), quantum theory of atoms in molecules (QTAIM) and reduced density gradient noncovalent interactions (RDG-NCIs). Moreover, 4-PT was compared with kojic acid in terms of its effectiveness as a tyrosinase inhibitor and anti-browning agent. The toxicity and physicochemical properties of 4-PT were predicted via ADME evaluation, which proved that 4-PT is safer than kojic acid. Experimentally, 4-PT (IC50 = 5.82 μM, browning index (10 days) = 0.292 ± 0.002) was proven to be an effective tyrosinase inhibitor and antibrowning agent compared to kojic acid (IC50 = 128.17 μM, browning index (10 days) = 0.332 ± 0.002). Furthermore, kinetic analyses indicated that the type of tyrosinase inhibition is a mixed inhibition, with Km and Vmax values of 0.85 mM and 2.78 E-09 μM/s, respectively. Finally, the mechanism of 4-PT for tyrosinase inhibition was proven by 1D, second derivative and 2D IR spectroscopy, molecular docking and molecular dynamic simulation approaches.

The article looks at the possibilities of employing halal regulation and certification to implement Islamic business practices in modern society. The current practices of halal regulation and certification, as well as the literature on Islamic business, were looked at to develop a workable plan for halal Islamic business. Islam recognizes and accepts various degrees of ethical commitment. A multilevel Islamic ethics framework and multilevel halal certification technique are offered to assist the application of Islamic business ethics in a relative setting. Two significant improvements may improve halal corporate practices: harmonizing global standards and governance structures and incorporating responsibility and ethical considerations into halal standards. Halal regulation and certification are effective instruments for assisting Muslims in adhering to their religious obligations in a globalized and diverse world. Disparities in the dependability and functioning of institutions and governance structures in various nations and sectors cause this diversity. Therefore, integrating specific tried-and-true methods from the field of CSR and incorporating ethics and responsibility criteria into halal standards may be used to produce halal regulation and certification. It may be accomplished via a multilevel strategy that provides Muslims with information about items and companies based on ethical and responsibility standards and Halal requirements.

The negative impacts of human activities on the environment have been generating considerable amounts of concern for several decades. Today, governments all over the world are making efforts to minimize human impacts on the environment. Understanding society's new concerns, businesses have begun to modify their behaviours while integrating environmental issues into organizational activities. This has led to the emergence of green marketing strategy which entails minimizing environmental pollution at all stages involved in the life cycle of products. It is essentially a market branding targeted at capturing the market by appealing to people’s desire to choose products and services that are better for the environment. Likewise, the Halal industry is witnessing unprecedented growth across the world and beyond religion barriers due to its pure, sustainable and ethical credentials or basis. The term ‘halal’ which means permissible or lawful and its compliment ‘toyyiban’, fundamentally implies production and consumption activities that are wholesome, of quality, healthy, green or environmentally sustainable. This strongly establishes the position that green production and green marketing had ever been inherent and integral parts of the Halal industry. Literatures have established that implementation of green marketing concept in the supply chain of the halal industry influences positive economic, environmental, and social impacts. Hence, this chapter examines the inherent relationship between Halal entrepreneurship and green marketing. It also explores how halal entrepreneurs can adopt best marketing strategies to project their green credential as a unique leverage and competitiveness of halalpreneurship.

To address the high failure rate of Muslim enterprises caused by the absence of such models, this chapter discusses the crucial importance of sustainable business models in Islamic entrepreneurship. Islamic entrepreneurship is a specific type of business endeavor that needs a special strategy because it has the dual objectives of profitability and Al-Falah (success in this life and the afterlife). The failure rate of Muslim-owned firms is greater than usual because many of them find it difficult to remain profitable while upholding Islamic ideals. To solve this problem, this chapter examines how Islamic and Halal business owners might create and employ sustainable business strategies. It goes into detail on the fundamentals of Islamic entrepreneurship, the significance of sustainable business models, and the particular difficulties experienced by Muslim-owned enterprises. The chapter emphasizes the necessity for a change to sustainable business models that agree with Islamic values by conducting a thorough analysis of the common causes of these failures. It gives Islamic and Halal company owners a manual for understanding and successfully implementing these models, resulting in enterprises that are lucrative and favorably impacting society in accordance with the principles of Al-Falah. In the chapter on future trends and prospects in Islamic entrepreneurship, it is emphasized how important innovation and technology will be in determining this future. It goes into detail on the fundamentals of Islamic entrepreneurship, the significance of sustainable business models, and the challenges faced by Muslim-owned enterprises. The chapter emphasizes the necessity for a change to sustainable business models that agree with Islamic values by conducting a thorough analysis of the common causes of these failures. It gives Islamic and Halal company owners a manual for understanding and successfully implementing these models, resulting in enterprises that are lucrative and favorably impacting society in accordance with the principles of Al-Falah. In the chapter on future trends and prospects in Islamic entrepreneurship, it is emphasized how important innovation and technology will be in determining this future.

Background Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital. Method This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients’ electronic medical records. Results There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19. Conclusion Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.

The increasing levels of carbon dioxide (CO2) in the atmosphere may dissolve into the ocean and affect the marine ecosystem. It is crucial to determine the level of dissolved CO2 in the ocean to enable suitable mitigation actions to be carried out. The conventional electrode materials are expensive and susceptible to chloride ion attack. Therefore, there is a need to find suitable alternative materials. This novel study investigates the electrochemical behaviour of dissolved CO2 on roughened molybdenum (Mo) microdisk electrodes, which were mechanically polished using silicon carbide paper. Pits and dents can be seen on the electrode surface as observed using scanning electron microscopy. X-ray diffraction spectra confirm the absence of abrasive materials and the presence of defects on the electrode surface. The electrochemical surface for the roughened electrodes is higher than that for the smoothened electrodes. Our findings show that the roughened electrodes exhibit a significantly higher electrocatalytic activity than the smoothened electrodes for the reduction of dissolved CO2. Our results reveal a linear relationship between the current and square root of scan rate. Furthermore, we demonstrate that saturating the electrolyte solution with CO2 using a bubbling time of just 20 minutes at a flow rate of 5 L min⁻¹ for a 50 mL solution is sufficient. This study provides new insights into the electrochemical behaviour of dissolved CO2 on roughened Mo microdisk electrodes and highlights their potential as a promising material for CO2 reduction and other electrochemical applications. Ultimately, our work contributes to the ongoing efforts to mitigate the effects of climate change and move towards a sustainable future.

The principal component analysis (PCA) is widely used in computational science branches such as computer science, pattern recognition, and machine learning, as it can effectively reduce the dimensionality of high-dimensional data. In particular, it is a popular transformation method used for feature extraction. In this study, we explore PCA’s ability for feature selection in regression applications. We introduce a new approach using PCA, called Targeted PCA to analyze a multivariate dataset that includes the dependent variable—it identifies the principal component with a high representation of the dependent variable and then examines the selected principal component to capture and rank the contribution of the non-dependent variables. The study also compares the feature selected with that resulting from a Least Absolute Shrinkage and Selection Operator (LASSO) regression. Finally, the selected features were tested in two regression models: multiple linear regression (MLR) and artificial neural network (ANN). The results are presented for three socioeconomic, environmental, and computer image processing datasets. Our study found that 2 of 3 random datasets have more than 50% similarity in the selected features by the PCA and LASSO regression methods. In the regression predictions, our PCA-selected features resulted in little difference compared to the LASSO regression-selected features in terms of the MLR prediction accuracy. However, the ANN regression demonstrated a faster convergence and a higher reduction of error.

Computer-mediated communication has dramatically transformed the human communication landscape by enhancing speed, content and social presence. The world has been experiencing a sharp decline in using email and phone calls due to organizations’ rapid adoption of instant messenger (IM) for their day-to-day communication with their stakeholders. Moreover, the world has been experiencing a sharp decline in using email and phone calls since the beginning of the IM era. Hence, the aim of this study is to comprehend the IM adoption process through the lens of three theories. A structured questionnaire was developed to collect data from the organizations and test hypotheses using consistent PLS-SEM (PLSc) in SMART PLS combined with bootstrapping. The results indicated that parallelism is the most dominating factor explaining IM adoption in organizations followed by transmission velocity, rehearsability and symbol set. The findings of this study also confirmed that team performance is not influenced by communication but by the quality of the communication and the level of knowledge within the group that can create using instant messenger. Indeed, this empirical study is one of the limited investigations that combine three theories to explain the IM adoption process and its effect on team performance. Moreover, this study contributes both theoretically and practically to comprehending the adoption process of IM. Lastly, this study reconfirmed the importance of Media Synchronicity Theory (MST) and Social Presence Theory (SPT) in predicting IM adoption; and the findings of this research extended the applications of the Adaptive Structuration Theory (AST) from the IM perspective, which is, indeed, rare. Finally, this study provides a great foundation for managers to understand the importance of IM in their day-to-day communication systems.

The role of end-of-life care is fundamental for end-stage renal disease (ESRD) patients, who are known to have a high morbidity and mortality rate despite being on dialysis. This requires effective communication and shared decision-making. Thus, exploring patients' knowledge and perceptions is essential to improve the gaps in delivering end-of-life care. This study aimed to describe the knowledge and perceptions of end-of-life care among ESRD patients on hemodialysis (HD). This was a cross-sectional study involving 14 outpatient HD centers in Kuantan, Malaysia. Patients were recruited from March to June 2019. A validated questionnaire was delivered via interview-based surveys by the researcher or trained interviewers. The majority of the respondents had poor knowledge of the disease and end-of-life care. However, more than 70% of the respondents felt that it was important for them to be actively involved in medical decision-making, as well as being prepared and planning for death. End-of-life needs, which included management of symptoms and psychological, social, and spiritual support, were important to most respondents. Additionally, patients with higher educational backgrounds were observed to have higher scores for both knowledge and perceptions ( P <0.05). The study found poor knowledge but acceptable perceptions among patients. This highlights the gaps in the current local approach in clinical practice to end-of-life care in ESRD.